LIBRARY OF CONGRESS. 



Chap........ Copyright No... 



UNITED STATES OF AMERICA. 



6H) 



THE CARE OF THE CHILD 
IN HEALTH 



■?&#*&■ 



THE CARE OF THE CHILD 
IN HEALTH 



BY 



NATHAN OPPENHEIM 

A.B. (Habv.), M.D. (Coll. P. & S., N.Y.) 

ATTENDING PHYSICIAN TO THE CHILDREN'S DEPARTMENT 

OF MT. SINAI HOSPITAL DISPENSARY 

AUTHOR OF "THE DEVELOPMENT OF THE CHILD " 

AND "THE MEDICAL DISEASES OF CHILDHOOD" 



THE MACMILLAN COMPANY 

LONDON: MACMILLAN & CO., Ltd. 
1900 

All right* reserved 



TWO COPihi. .Jt-OEIVED, 

library uf C»ngr Q t% 
Office of the 

MAY ] 2 1900 

Ulster of Copyrltfiit^ 

SECOND COPY, x 

o 

59105 



Copyright, 1900, 
By THE MACMILLAN COMPANY. 



KToriwooti $regg 

J. S. Cushing & Co. — Berwick & Smith 
Norwood Mass. U.S.A. 



^ 






Co mg lister 

C. L. G. 



CONTENTS 

CHAPTER PAGE 

I. Introductory ....... 1 

II. The Pregnant Woman ..... 23 

III. The B art's Outfit and Nursery . . 47 

IV. Feeding 70 

V. Bathing Ill 

VI. Sleep , . .128 

VII. Exercise 146 

VIII. Clothing from the Time of Infancy . . 163 

IX. Habits 180 

X. Relation of Parents to Children , . 204 

XL Education , 225 

XII. Defective Children ..... 251 

XIII. Common Diseases 270 



THE CARE OF THE CHILD 
IN HEALTH 

CHAPTER I 

INTRODUCTORY 

It is not hard to imagine the glow of enthu- 
siasm with which a young man begins his 
college life, enters a profession, or starts a 
business. All the traditions of his vocation, 
all the prospects of success, and the expecta- 
tions of a useful development of his faculties 
combine to make a state of mind that becomes 
capable of surmounting obstacles, providing a 
rational outlet for natural energy, of giving a 
guiding point by which his various impulses 
are directed. His intellectual status and the 
usefulness of his future work may be measured 
not so much by their separate effects and acts 
as by the informing spirit which controls them. 
Such things have an inevitable sequence of 
action, on account of which the superior man, 

B 1 



2 THE CARE OF THE CHILD IN HEALTH 

the person of high mind and character, selects 
an admirable field of work, or such a field as 
is susceptible of being dignified by the exercise 
of thorough work and preparation, of thought- 
ful attention to details, of a large grasp of the 
inherent potentialities of the vocation, which 
marks it off from the sordid and petty affairs 
of ordinary, petty life. Great results are not 
obtained by a preternatural flash of wondrous 
inspiration. On the contrary, they rest upon 
unremitting toil, upon tireless industry, upon 
an endless struggle with adverse conditions, 
the conquering of which means a great step 
toward the final evolution of civilization. 

This is the basis of genius, and a careful 
examination of the works of any great man will 
show how scrupulously he has met the demands 
of the situation. Leonardo da Vinci was will- 
ing to grind his own colors, and make his own 
paints in order to obtain the desired effects ; 
and in the wide range of activities in which 
he was proficient there was no detail too small 
or too burdensome to be carefully mastered. 
William Morris, who was great in both poetry 
and art, in order to produce works of beauty 
became a printer, a dyer, a weaver. There was 
no labor too commonplace, no outlay of time 



INTRODUCTORY 3 

too great, no course of study and investigation 
too exhaustive, for his industry. Such men 
have achieved the great things of the world, 
and no one who is unwilling to recognize the 
truth of their methods is able to lead a really 
profitable life. Such a life cannot be passed 
in an atmosphere of carelessness, of disregard 
of duty, of a perpetual avoidance of burdens. 
Whatever truth there is in this view has a 
universal, not a particular, application; and 
men in every walk of life must recognize it in 
their work, or lacking this recognition must 
fail. Every citizen of the world has his share 
of work to do and problems to solve ; and the 
true judge of whether the doing and the solv- 
ing are successful is not entirely the opinion of 
existing authority, but rather the ideal, based 
upon the most objective conception of the 
worker's intention, as well as his performance. 
A vigorous sense of responsibility is, after all 
has been said, at the root of a really profitable 
career. Expediency must have no part in it, 
and makeshift devices must necessarily end in 
some form of worthlessness. The inner spirit 
of a piece of work is as worthy of scrupulous 
attention as the outer form. The one stands 
for everlasting principle, while the other repre- 



4 THE CARE OF THE CHILD IN HEALTH 

sents the adaptation of that principle to the 
exigencies of practical circumstances. And the 
perfect blending of these two factors rounds 
out a life-work as well as a character. It 
must be said that an appreciation of this truth 
is oftener found among men than among women. 
Such a statement is hard to make; it really 
hurts in the saying, especially if one has a 
normal respect for the many excellences of the 
womanly character. But an impartial observa- 
tion of life necessarily leads one to this conclu- 
sion; and what one sees must be said. 

There could not be a better demonstration of 
the unprejudiced truth of this idea than may 
be had from recognizing the methods which 
women employ in caring for their children. 
Such methods constitute a fair standard of com- 
parison because they are the principal occupa- 
tion of a majority of the really useful women in 
the world. Those women who are regarded as 
fortunate have as their vocation and life-work 
the bearing and the rearing of offspring. They 
grow up from girlhood with the hope and the 
belief that such work will be their future call- 
ing. Every other employment is frankly re- 
garded as subsidiary, as a temporary means of 
gain or occupation, which is to be gladly and 



INTRODUCTORY 5 

unhesitatingly relinquished when the great 
opportunity presents itself. This great oppor- 
tunity usually seems so natural and inevitable 
that its demands are supposed to work them- 
selves out in quite an irresponsible fashion, 
fully as irresponsible as the choice of a spouse 
commonly is. On the other hand, the necessi- 
ties of competition demand a certain amount 
of preparation for obtaining even a low grade 
of commercial work, and, for a similar reason, 
a fair amount of effort is demanded to hold the 
position. Naturally enough, women recognize 
this fact, even if they have not thought about the 
matter very much ; but they go no farther than 
the barest demands of competition, because they 
recognize, and the world at large recognizes, 
that the ordinary commercial employments are 
for them scarcely more than a temporary means 
of gain or occupation. At the same time, the 
corollary of the proposition is that household 
and maternal duties are their permanent work, 
for which they are peculiarly designed and 
adapted, and in which they are expected, in the 
scheme of nature, to find their greatest gratifi- 
cation as well as usefulness. 

A recent writer in a popular American maga- 
zine, in expressing the discontent of the women 



b THE CARE OF THE CHILD IN HEALTH 

of to-day, cries out: "Give us labor! For 
countless ages, for thouands, millions it may 
be, we have labored. When man first wan- 
dered, the naked, newly erected savage, and 
hunted and fought, we wandered with him; 
each step of his was ours. Within our bodies 
we bore the race, on our shoulders we carried 
it; we sought the roots and the plants for its 
food; and when man's barbed arrow or hook 
brought the game, our hands dressed it. Side 
by side, the savage man and the savage woman, 
we wandered free together and labored free 
together. And we were contented." She then 
goes on to explain that as uncivilized conditions 
changed to civilized, the woman had less and 
less work to do, until to-day the race is in 
danger of degeneracy on account of her weak- 
ness, her lack of occupation, her unsatisfied con- 
dition of mind, and her increasing parasitism. 

This cry for work is, in a certain way, aston- 
ishing, for the common belief has been that one 
of the main tendencies of the modern woman 
was away from the field of hard, manual labor, 
away from the personal performance of house- 
hold duties which naturally constitute the 
quoted writer's "work." And this belief is 
very commonly held among various classes in 



INTRODUCTORY 7 

society at large. It is often stated to be at the 
root of the increasing difficulty in supporting a 
household. At all events, we see that mar- 
riages are being contracted at a later age than 
formerly and with more difficulty ; that house- 
holds are conducted on a more extravagant plan 
than was ever customary ; that less work is done 
by mistresses, and that the spread of luxury is 
ever increasing. It is claimed that children are 
no longer willing, in planning the externals of 
their prospective careers, to begin where their 
parents began, and to go through the same 
laborious course of financial evolution. On 
the contrary, they want to begin where their 
parents left off, evidently believing that a 
change in external circumstances and the de- 
tails of social environment in the direction of 
simplicity was not to be endured, and meant 
a fall in public estimation. 

An additional fact of interest is the change 
that has gradually been taking place in com- 
mercial life. There is a growing competition, 
there is an increasing development of business 
methods which requires more energy, more 
capital, more industry for the successful prose- 
cution of a business enterprise than ever before. 
The successful business is falling more and 



8 THE CARE OF THE CHILD IN HEALTH 

more into the hands of groups of wealthy capi- 
talists, or into those of one unusually active 
man who often represents a group or syndicate. 
As a result, many persons who formerly con- 
ducted individual enterprises must now be con- 
tent to accept salaried positions whose pay is 
not great, either actually or prospectively. The 
most characteristic thing which one can say is 
that the plan of specialization is extending into 
every business and into the individual depart- 
ments thereof; and that while there are a few 
places which are highly remunerative, the gen- 
eral salary does not tend to increase, the indi- 
vidual wage cannot be expected to grow larger. 
Thus, as the result of the centralization of re- 
sponsibility as well as capital, a larger and larger 
proportion of the possible situations are subor- 
dinate. Such positions must from their nature 
require less of the qualities of the proprietor 
and more of the qualities of the employee. They 
must be administered by persons who have com- 
paratively little personal connection with the 
intimate policy and welfare of the enterprise, 
who may be as useful to one firm as another, and 
who are ready to change from one to another 
according to the demands of a passing necessity 
or the whims of personal preference. 



INTRODUCTORY 9 

This has made the opportunity for thousands 
of women to participate in business life. They 
feel the constant impulse to increasing luxury, 
their needs are not so easily satisfied as formerly 
by the wage-earning head of the family, and 
during the interregnum between the period of 
their entire dependence and the equally distinct 
period when by marriage they believe that entire 
independence must come, they endeavor to 
piece out their possibilities of enjoying life, of 
gratifying their desire for petty luxury, and, 
possibly, for the present large necessities of life, 
by obtaining subordinate positions. They are 
able to accept less pay than the wage-earning 
head of the family, because their needs are less. 
And at the same time, on account of the divi- 
sions and subdivisions of specialized business, 
they are able to do the work almost as well, or 
fully as well as he does. Many of these posi- 
tions — being subordinate, having comparatively 
little responsibilitjr, being merely functional — 
demand no more than a special, narrow prepara- 
tion, for which the ordinary woman, whose 
needs are immediate and whose prospects are 
liable at any time to undergo a radical change, 
is almost as well fitted as her brother. He, on 
the other hand, knows that he must continue 



10 THE CARE OF THE CHILD IN HEALTH 

for the rest of his life to be a wage-earner; and 
his prospects, in all likelihood, will never 
change unless he, by his own power and re- 
sourcefulness, is able to bring the change about. 
When the woman comes to marry, as she 
naturally and inevitably hopes to do, she finds 
that her husband's income does not permit the 
same indulgences to which she has become 
accustomed. They are certainly not possible 
without the exercise of rigid economy, personal 
willingness to do many pieces of work in the 
household, intimate knowledge of all the de- 
tails of household management, and a full 
experience of all the homely details that make 
for the family's prosperity or lack of prosperity. 
It is really rare that the woman tries in a sys- 
tematic way to familiarize herself with and to 
perfect herself in all these details. Her cook- 
ing is done as it was learned, by haphazard, by 
rule of thumb, by the patchwork knowledge 
which comes from indiscriminate attempts and 
unregulated experience. She has no acquaint- 
ance with the physiology of nutrition, and is 
utterly unable to regulate her meals so that the 
maximum of strength is distributed at a mini- 
mum cost. She knows very little about fabrics, 
about dressmaking ; but she needs costly clothes 



INTRODUCTORY 11 

or imitations of such clothes. She knows noth- 
ing about the care of her children, about the 
rules which will increase their measure of 
health, strength, and useful training; but she 
feels the necessity and the fitness of handing 
the care of these children over to nurses and 
teachers. She has, in short, lost the sympathy 
for a plain, modest, hard-working, homely life, 
without at the same time being capable of pro- 
viding a more efficient plan of work than her 
grandmothers possessed. 

In the wealthier classes the situation is as 
bad, or possibly worse. Girls are willing to 
contract marriage without much thought of their 
probable responsibilities, and wish even less 
preparation and training for their certain duties. 
I believe that there is no exaggeration in the 
statements about their wishing to begin their 
active life in circumstances which are equiva- 
lent to those obtained by their parents after a 
long period of effort. Of course there are 
exceptions, as there always are to any broad 
generalization. But the statement, as a rule, 
holds good. Manners of living are undoubtedly 
more extravagant than ever before, fashions of 
dress are more extravagant than ever before, 
the amount of personal work which is supposed 



12 THE CARE OF THE CHILD IN HEALTH 

to be done by the wife and mother is smaller 
than ever before. These customs are to be 
commonly found among the women of the more 
fortunately situated classes, and they necessitate 
larger numbers of servants, lessened attention 
on the part of the mistress, greater expense and 
wastefulness in the management of the house. 
And as the natural energy of these women must 
find some outlet, it shows itself in distortions 
from its normal manifestations, which have been 
called all manner of hard names by one part of 
the community and all manner of fine names by 
another. These fads do not call for great praise 
or great blame, any more than neurasthenia or 
indigestion should be praised or blamed. They 
should be regarded as the natural expressions of 
certain conditions of life ; and if these manifes- 
tations are unsatisfactory and burdensome, relief 
may be obtained by changing the conditions 
which produced them. 

The inevitable result of these tendencies is a 
progressive increase in the burdens of the whole 
household. Difficulties are piled upon the 
man, and dissatisfaction becomes the lot of 
the woman. He suffers from care, worry, and 
the lack of opportunity to cultivate the finer 
and gentler parts of his nature. She becomes 



INTRODUCTORY 13 

more artificial, more worldly, more self-seeking 
than she formerly was or than she ought to be. 
Each comes to have a separate world, which 
has few points of contact with that of the other. 
Concord gives way to discord, intimate affection 
to indifference; and, finally, the end of the 
matter is strife or unhappiness. Under such 
circumstances it is easy to understand the recent 
cry that marriage is a failure ; for nothing but 
failure can attend any enterprise which is not 
founded upon mutual understanding, common 
effort, and a common purpose. It makes very 
little difference whether the enterprise is in the 
way of commercial management or domestic 
management; the salient rules that govern the 
one may with equal justice be applied to the 
other. In both there is the strongest need to 
recognize fundamental requirements, to prepare 
for the efficient administration of them, and to 
undertake the working out of such requirements 
to their logical results which an elevated ideal 
demands. 

The problem which the present time has to 
solve is the adaptation of its domestic conditions 
to the changed circumstances of commercial life. 
We must revert to the state where the women 
of a household had as active a share in its for- 



14 THE CARE OF THE CHILD IN HEALTH 

tunes as men, where the women's responsible 
positions and occupations were as sharply de- 
fined as men's, where natural energy had as 
wholesome a method of expression in one as in 
the other. The woman of to-day is a more 
intelligent creature than her predecessor and 
ancestress of the eighteenth or seventeenth cen- 
tury. She has larger needs, a larger range of 
potentialities, and an enlarged outlook. These 
opportunities are fine things in their way, but 
they bear with them their commensurate share 
of responsibility. The woman of to-day has 
greater privileges than ever before; but also 
she must know that her duties should likewise 
be interpreted in a more developed and more 
strenuous manner. Instead of giving less of 
herself to her duties, she ought to give more ; 
she ought to bring to her work an increased 
zest, a more logical method, a greater efficiency 
than was formerly expected. There must be a 
distinct correspondence between what she ex- 
pects to give and what she expects to get. The 
demands of the past, instead of being lessened, 
ought in all likelihood to be increased, for in 
no other way can the progress of the world be 
furthered. The spirit of the present time de- 
mands thoroughness of preparation, intensity, 



INTRODUCTORY 15 

and devotion to principle in a greater degree 
than at any other period. And women must 
participate in this movement to as great an 
extent as men. The well-meant efforts of many 
women to increase the family's income, and to 
obtain an outlet for their own activity by plung- 
ing into business enterprises cannot go to much 
further lengths without evil consequences. 
For the stability of the home and domestic in- 
stitutions will inevitably be adversely affected. 
Women must, in the final analysis, be the ones 
who set the standard of the home ; and the ideals 
and practices which they represent are the pat- 
terns by which the household will be guided. 
The further inquiry about what means may 
be employed to remove the disabilities and the 
hardships of women in particular and families 
in general will be best answered by considering 
certain fundamental facts, and holding to cer- 
tain elementary truths; and when these facts 
and truths have been ascertained, the next step 
consists in adapting the current conditions of 
life to them. We must recognize that domestic 
careers exist, and have their value in the scheme 
of existence, just as surely as commercial or 
professional careers. They are not the simple 
pursuits that the general public so commonly 



16 THE CAKE OF THE CHILD IN HEALTH 

takes them to be, but, on the contrary, demand 
as thorough preparation and as intelligent study 
as any other work. The objects which they are 
intended to serve are among the worthiest and 
the most vital which can occupy human atten- 
tion, for they include not only the comfort and 
the social progress of the family, but its very 
existence as well. In former times, when the 
opportunities which women possessed of going 
out into the world and mingling in its struggle, 
its successes, and failures, were very limited or 
did not exist, there was no choice for them but 
to stop at home and devote themselves to the 
occupations which the home provided. In those 
times they wove the cloth which clothed the 
family; they made the candles that illuminated 
the house; they preserved the fruits and the 
meats that were to last over the hard season of 
winter. The man had one work in the outer 
world, the woman had another in the inner. 

As customs changed, as labor-saving inven- 
tions grew in number and complexity, the bal- 
ance became disturbed, the unprotected position 
of men forced them to observe the changes and 
keep in consonance with them. The compara- 
tively protected and isolated position of women 
allowed them to go on in much the same chan- 



INTRODUCTORY 17 

nels as before, and did not necessitate as prompt 
and entire a conformity to the new methods. 
As the result of inventions and new methods, 
wealth increased; but the demands of business 
and professional life became greater, and the 
standards set for success became higher. Men 
acquiesced with comparative readiness in the 
new demands and the new standards, and thus 
the business part of the world has gone on with 
no more than temporary disturbances and inter- 
ruptions. There are many persons now living 
who well remember the hardships and indus- 
trial disorders that arose from the extensions of 
railroads into territory where the carrying trade 
had previously been done by sail-power, horse- 
power, or man-power. And the consequent 
changes occasioned local hardships, local up- 
heavals, local dissatisfaction. But these were 
no more than temporary phases which in the 
course of a few years passed away, and were 
replaced by other and superior industrial con- 
ditions. The hardships gave way to ease, the 
upheavals to quiet, the dissatisfaction to con- 
tent. The business life of these localities 
increased and flourished, for the business men 
saw the futility of stupid resistance, they 
recognized the demand for newer plans of work, 



18 THE CARE OF THE CHILD IN HEALTH 

they welcomed the prospect of greater outlays 
of specialized skill. 

Let us ask in all fairness whether similar 
changes, and free acquiescence in their neces- 
sity, have come about in household manage- 
ment. And in making the inquiry I am not 
impelled by any manner of sex-feeling or 
sex-jealousy. For I recognize to the full the 
valuable parts of women's character, their pos- 
sibilities of self-sacrifice, their generous will- 
ingness to respond to worthy appeals, and their 
fund of devotion to a worthy cause. At the 
same time, it is quite clear that they have not 
participated fully enough in the spirit of the 
age which calls for a clear-sighted view of the 
exigencies of everyday life. They, as well as 
men, know that a woman's work has always 
been and must always be connected with the 
home. The best exponents of the sex have 
never attempted to deny this, and at most have 
justified the taking up of business careers and 
the desertion of home life on the plea of para- 
mount necessity. The whole excuse is that the 
man is not able to accomplish enough alone, is 
not able to make enough money to support the 
family on the scale that has become common ; 
and that therefore the girls and the women must 



INTRODUCTORY 19 

leave their homes to help them. In the mean- 
while much of the necessary work is done by 
various servants, who, in turn, want to help 
their families. 

Another and more logical solution of the diffi- 
culty is possible. The woman must recognize 
and conform to the greater demands for special- 
ized work. Since being a wife and mother is 
her best and natural profession, she must fit 
herself for its duties ; and she must clearly have 
in mind the greater needs and the more compli- 
cated duties which the present time demands. 
She need not weave cloth for clothes, she need 
not dip candles, she need not collect potash and 
fat for soap-making. But she has other work 
that requires a greater degree of study and 
preparation for its learning. She must know 
that these times require a keener intellect and 
a greater energy than any former period in the 
world's history, and she must fit herself to 
develop such qualities in her husband and chil- 
dren. These things cannot be learned after she 
has become a wife, for then, and before then, 
they must have been in active working. Long 
before she assumes these tremendously important 
duties, she ought to know how the greatest 
amount of nutrition is to be obtained from the 



20 THE CAKE OF THE CHILD m HEALTH 

smallest expenditure of time and money, what 
nutrition means, and how it may be obtained 
and conserved. She must know what work is 
to be done in a household, how and when it is to 
be done, as well as every advanced method by 
which one may augment the health, comfort, 
and pleasure of the family. She ought to know 
what health is and what sickness is, how one 
leads into the other, and the wonderful changes 
that can be accomplished with a knowledge of 
hygiene, and sanitation, and elementary biol- 
ogy. She must have information of her pro- 
spective duties as a mother, so that the birth 
of a child may be an occasion for rejoicing 
rather than a harbinger of extravagant outlay, 
largely increased household expenses, and 
domestic disorder. She must know what the 
child's growth entails, what demands will be 
made upon her store of information and inge- 
nuity. She must, most of all, be prepared to 
take entire charge of her offspring, recognizing 
that this is the proper and natural outlet for her 
self-sacrifice, her willingness to respond to 
ideals, and her devotion to worthy causes. 
Moreover, she must constantly have the convic- 
tion that she is morally responsible for all these 
facts and conditions; that the burden of duty 



INTRODUCTORY 21 

weighs upon her just as heavily as if she were 
working under a written contract. Indeed, she 
ought to feel the responsibility even more keenly 
than any form of mercantile agreement could 
make her realize. As matters now stand, the 
woman, as soon as she marries, is apt to feel that 
she is answerable to no one, and that there is 
no standard for her work except the one which 
she chooses to elect. But as surely as such a 
plan would work disaster in business affairs, 
just so certainly must it produce domestic 
irregularity, disorder, and failure. 

The proper sphere for women is not to fight 
in the outer world for a miserable wage in 
dollars. Her potentialities are too fine for that, 
and in submitting herself to the consequent 
competition she is losing too much. She is 
much more able to save at home, to prevent 
countless occasions of waste, to raise the 
standard of healthfulness, of self-reliance, and 
usefulness in her husband and children, so that 
the burden of support is not too heavy for a man 
to bear. If she accomplish that, if she can ac- 
quire a good enough sense of proportion so that 
the foolish tendencies to artificial extrava- 
gances of methods and household manners are 
kept within bearable limits, she will do a great 



22 THE CARE OF THE CHILD IN HEALTH 

deal to end the competition between the sexes. 
Such competition is unnatural, unprofitable, not 
susceptible of a desirable outcome. The cry, 
"Give us labor! " is right; for no one can live 
without work, and enough work. But let us be- 
ware lest we look far off for this opportunity to 
expend our energies and develop our characters, 
while we are unmindful of the opportunities 
which lie immediately before us, so close, in 
fact, that we stumble over and tread upon them. 
The change must come, not from without the 
household, but from within it; not by the 
woman's entering into competition with her 
father, husband, and brother in sorts of work 
where she must necessarily occupy an unde- 
sirable position, but by increasing her value at 
home, by diminishing the amount of needless 
waste — in a word, by fitting herself for her 
vocation as carefully as she would if she wished 
to employ her male relatives in a commercial 
labor of value and responsibility. As much as 
home-content is better than home-discontent, as 
much as peace is better than discord, as much 
as real prosperity is better than artificial show, 
so much is the true training of women better 
than what is so commonly given. "Give us 
labor! " is a good enough cry; but "Let us do 
the labor that is within our hands ! " is a better. 



CHAPTER II 

THE PREGNANT WOMAN 

The pregnant woman is the centre of the 
world's progress; she must regard herself as 
endowed with a great responsibility, whose 
pleasures are as sweet, and whose possibilities 
for good are as vast as those of any position in 
life. She should look upon herself not only as 
the giver of a living pledge to her husband, 
but also as the transmitter of humanity itself, 
of all its endeavors, hopes, and aspirations. 
Her function, while on the one hand private 
and domestic, is on the other a matter of world- 
note, of the upbuilding of the race and the 
working out of every right-minded dream of 
the poet and philosopher. She must realize that 
in this matter, as in every other in human 
affairs, there is a necessity for exact prepara- 
tion, for the discernment of elements of strength 
and weakness, and for the recognition of the 
methods which will increase the advantages and 
decrease the disadvantages of the situation. 

23 



24 THE CARE OF THE CHILD IN HEALTH 

The pregnant woman should recognize that 
one of the best preparations for the efficient 
future of her child is the efficient present care of 
herself. In this condition the welfare of both 
is so closely interwoven that a point of separa- 
tion between them cannot reasonably be made. 
During this preparatory period the child is 
growing and developing, is laying the founda- 
tion for the future blossoming of mind and 
body, just as surely as in the later times when 
he requires meat and drink, shoes and caps, 
gowns and books. From the very moment of 
conception he begins to be a human being with 
definite needs; and carelessness of his welfare 
during his prenatal existence is fully as inex- 
cusable as ignorant and stupid ordering of his 
affairs after birth. His various physical re- 
quirements and functions have as distinct an 
existence at one time as at the other. Instead 
of breathing through his lungs, he breathes 
through the maternal placenta ; instead of ab- 
sorbing food from his stomach and intestines 
into his blood, he is nourished directly by the 
blood of his mother. If her blood is poorly 
oxygenated and nourished he feels the effect 
immediately and intimately. And in propor- 
tion to his extreme feebleness and immaturity 



THE PREGNANT WOMAN 25 

he must necessarily be well or ill influenced. 
But the main fact that physiological activity 
exists is as true of one time as the other. 
Nothing can possibly be more important, from 
the standpoint of the collective welfare as 
well as that of the individual, than a dis- 
criminating knowledge of the relations of 
parent and child; in other words, of heredity. 
The general belief that descent acts in some 
blind and unchangeable manner is not only 
wrong, but also infinitely mischievous. While 
the oft-quoted aphorism that a child's training 
should begin two hundred years before his birth 
may be true enough, nevertheless a highly 
important fact which calls for an equal amount 
of consideration is that the immediate progeni- 
tors have a great part in the matter of a child's 
health and strength ; and that, most of all, the 
nourishment which the mother can and does 
give before his birth will have much to say in 
deciding what manner of person he may grow 
to be. And when one speaks of health and 
strength, the terms have so wide an application 
that they include the vitality of bone, muscle, 
and nerve tissue, of body and mind. 

Thus the prospect of the child's birth must 
be a matter of constant thought and preparation, 



26 THE CAKE OF THE CHILD IN HEALTH 

not only in the way of providing for his physi- 
cal requirements, but also in so disposing of 
the mother's forces and energies that she will 
undergo the minimum of wear and tear while 
obtaining the maximum of normal activity. 
She must maintain a calm and placid mind, 
should try to develop a cheerful manner of 
looking at the world, must endeavor to see the 
beauty of life and all its relations. In olden 
times the Greeks decorated the rooms of preg- 
nant women with beautiful statues, that the 
mind, dwelling on the images of strength and 
loveliness, might obtain a more favorable im- 
pression than it formerly had, and thus would 
hand on to the new-born child a heritage of a 
like nature. While the physiological ideas 
involved in this custom may have been misty, 
nevertheless, there was a large element of prac- 
tical truth in it; for the woman who realizes 
that she can to a notable extent, by controlling 
and regulating her physical and mental condi- 
tion, mould the body and mind of her unborn 
child, has progressed to an appreciable extent 
in the direction of being an ideal mother. Such 
a woman will keep a strict account of her 
thoughts and emotions, will try to encourage 
beautiful and worthy ideas and ideals, will 



THE PEEGNANT WOMAN 27 

endeavor to make her everyday life square with 
these theoretical conceptions, and similarly 
will eliminate unfavorable acts and their con- 
sequences. Nothing that in any way affects 
her will be considered as trivial, for every fact, 
whether it is great or small, has its commensu- 
rate influence. Similarly, no burden of pains- 
taking will be too great for her strength; for 
she is the beginning of generations that may 
change the face of the world. The stimulant 
for good of such a course is not to be overesti- 
mated; it will serve as a pillar of cloud by day 
and a pillar of fire by night to guide and re- 
strain; it will keep alive the sense of respon- 
sibility and promote the conviction that the 
pregnant woman is one of the real makers of 
the world and its destinies. Viewed in this 
light, the condition represents a great oppor- 
tunity whose importance, as far as the welfare 
of the community is concerned, is not exceeded 
by that of any profession or vocation in the 
world. 

It is noteworthy that a belief in prenatal 
effects upon the child has from times imme- 
morial been more or less prevalent, although as 
commonly interpreted it has no foundation in 
fact. The so-called maternal impressions are 



28 THE CARE OF THE CHILD IN HEALTH 

no more than fortuitous thoughts and accidents 
which are supposed to leave their impress in 
some indelible manner upon the child. Thus, 
as an example, a woman may be frightened by 
the sight of an ugly or deformed person, by an 
accident, by some chance blow, fall, or misstep ; 
in other cases she may have had bad dreams 
whose grotesqueness haunts her even during 
the waking hours ; in yet others, she may have 
heard some shocking news, or may even be 
afflicted by an equally disturbing train of 
thoughts which fascinate her by their persis- 
tence and ugliness. In almost all cases the 
apprehensions are ill founded and should re- 
ceive no attention. It is a noteworthy fact that 
the most fanciful and easily alarmed women 
encounter the greatest number of alarming 
sights and accidents, and are afflicted with the 
most stubborn obsessions. Nevertheless, these 
very women in the greatest number of cases 
bear children who show no marks of injuries ; 
and where such abnormalities appear, their oc- 
currence can usually be explained on other and 
more reasonable grounds. If one wishes to 
state the matter in the form of a general rule, 
one should say that the growth of a child before 
birth is as regular and as fully subject to physio- 



THE PREGNANT WOMAN 29 

logical laws as after birth, and that on account 
of the protecting circumstances of the foetus, 
ordinarily trivial accidents rarely produce im- 
portant results; moreover, the main factor in 
the infant's development is the normal nutri- 
tion of the mother, her healthful activity, and 
the wise regulation of her daily life. 

Thus a woman in the course of a visit or an 
afternoon walk may see a cripple or an invalid, 
or may be startled by some animal; in other 
cases she may inflict some slight injury upon 
herself, or may encounter another person who 
has undergone an accident. In such cases it is 
no uncommon experience for her to begin a 
course of worry, of self-tormentings, of belief 
in the possibility that her child may bear in his 
body or mind the likeness of these events. As 
a matter of plain fact she is doing more harm by 
the worry than the thing which she fears can 
ever accomplish. For if such a transitory con- 
cept could have any power, then similarly every 
act and experience of her daily life would be 
faithfully portrayed in her offspring. Such a 
connection would result in a child that was a 
veritable patchwork, a freak, or a monstrosity. 
It is absolutely opposed to every rational inter- 
pretation of ordinary children as we see them 



30 THE CARE OF THE CHILD IIST HEALTH 

from day to day. If a defect does finally 
appear, its origin assuredly has a more logical 
basis than such fleeting cloud-shadows. There 
must rather be some more organic defect present 
in the child's nourishment, which is translated 
into a local or general manifestation, according 
to the various circumstances of the case. This 
is normally regulated by the mother's general 
condition rather than fortuitous impressions 
which come from without. 

There is an additional and noteworthy 
thought which if fairly considered ought to 
clear up one's ideas about maternal impres- 
sions. If a passing emotion or impulse of an 
unfavorable nature can injure the unborn child, 
why should not every happy emotion or impulse 
benefit him ? If the sight of a cripple can blast 
his growth, why should not the sight of a finely 
formed person benefit him ? If the hearing of 
bad news can depress the future gayety of his 
mind, why should not the reception of good 
news equally elevate it ? Practically always 
one hears of injurious maternal impressions, 
never of helpful; and. this irrational lack of 
consistency merits some common-sense think- 
ing. One can always offset the bad impres- 
sions by possible good ones, so that the result 



THE PKEGNANT WOMAN 31 

of the comparison is equality. This is really 
the normal view to take; and it has the further 
advantage of imparting a healthy control of 
mind and body. 

Such control involves an intelligent oversight 
of all the ordinary faculties and functions. 
The pregnant woman ought to have a diet 
which, although liberal, excludes articles of food 
that are hard to digest or have small nutritive 
properties. Thus, all fried foods, "made" 
dishes and salads, greasy and fatty preparations, 
and pastries should be avoided; coffee and tea 
may be taken in moderate quantities, and light 
and effervescent whines may similarly be advised. 
The ordinary meats, fish, fresh vegetables, and 
fruits must constitute the meals rather than 
dainties, relishes, and the usual articles that a 
fickle, capricious, and sometimes morbid appe- 
tite may seek. In fact, this element of nor- 
mality should be the keynote of her daily 
routine. Instead of searching for, recognizing, 
and exaggerating abnormal factors, she should 
in every possible manner repress them. Her 
condition is not an unnatural one ; on the con- 
trary it is one that is physiologically charac- 
teristic of her whole being. This view will 
tend to dispel many of the perplexing doubts 



32 THE CARE OF THE CHILD IN HEALTH 

concerning the arrangement of her time. The 
day may well be begun by a pleasantly cool 
shower- or plunge-bath on arising. This bath, 
since it lasts for a very few minutes, and since 
it should be followed by a brisk rubbing of the 
body, is not too severe for even a delicate or 
nervous person. Then there will be a greater 
zest to the appetite, and the light breakfast of 
fruit, cereal, eggs, and chops will be more 
eagerly welcomed than otherwise. After 
breakfast, and as soon as household duties per- 
mit, she may take a walk, the length and ra- 
pidity of which are proportioned to her energy 
and vigor. The remainder of the morning may 
be devoted to her ordinary domestic work. 
After lunch she should take a nap for about an 
hour, which may be followed by another walk, 
drive, or visiting. In the evening the ordinary 
domestic recreations may pass the time, and 
occasionally she may see a play at the theatre 
or hear a concert. Especially on such occasion 
she must resist the temptation to remain up 
late, for sufficient sleep is one of the main fac- 
tors in a healthful life, most of all for a woman 
who has to supply nerve energy not only for 
herself, but for her unborn child as well. The 
proverb " qui dort dine " applies to such a person 



THE PREGNANT WOMAN 33 

with more force than in all likelihood to any- 
other; and its good effects will be seen in les- 
sened emotional disturbances, fewer nervous 
manifestations, and rarer complaints of inordi- 
nate fatigue. 

Such a general scheme as the above may 
seem difficult of accomplishment to some women 
who believe that the demands of their house- 
hold and growing family take up all their avail- 
able time. While in some cases reasons of 
domestic economy prevent as much liberty as 
one might desire, nevertheless, in most homes 
— even those that are supported on moderate 
incomes — the wife's time and energies are often 
unnecessarily frittered away in a poorly arranged 
plan of work and superintendence. Indeed, 
one of the greatest needs in the ordinary house- 
hold is a carefully arranged system by which 
each certain piece of work is made to begin and 
end at its fixed time, where there is the ex- 
change of duties between different members of 
the family or between different servants, where 
every routine need is provided for in a schedule 
that should be as direct and businesslike as 
the working of a successful factory or mercan- 
tile establishment. If this is done, and I know 
by experience that it is not impossible or un- 



34 THE CARE OF THE CHILD IK HEALTH 

reasonably difficult, the increased opportunities 
for exercise, recreation, and care of self which 
the ordinary wife and mother may find at her 
command will be sufficient and gratifying. 
Wherever there is an accumulation of duties 
and work, or the presence of several persons 
with their various needs and desires, there must 
be a controlling discipline, which will regulate 
conflicting interests, prevent loss of time, and 
promote good feeling and ease of temper. 
Doubtless there is no place where wise manage- 
ment can be better demonstrated than in the 
ordinary household. 

Of all the subjects of preparation which the 
pregnant woman must consider, none is more 
susceptible of intelligent management than her 
method of dressing. If this matter is poorly 
arranged she will experience discomfort, un- 
dergo unnecessary expense; she may suffer in 
health and surely will present an ungraceful, 
uncouth, and, possibly, immodest appearance. 
But such undesirable conditions need not ex- 
ist, and, indeed, may with the help of proper 
costumes be replaced by those that are con- 
venient, healthful, and seemly. Clothing 
may, unfortunately, cover one's nakedness, and 
yet suggest too much of the form ; it may pro- 



THE PREGNANT WOMAN 35 

tect the body from heat and cold, and yet the 
protection may be partial or unevenly distrib- 
uted; it may decorate, and yet not beautify. 
Knowing these things we must try to select and 
make the clothing of the pregnant woman with 
a view to providing a sufficient lightness, 
warmth, freedom of movement, and a due 
regard for appearances. While in ordinary cir- 
cumstances it is not desirable either to follow 
the changing modes too slavishly or to neglect 
them so completely as to make the impression 
of eccentricity, in the special period of preg- 
nane}' a woman should subordinate the usual 
obedience to the current styles to the reasonable 
demands of health and convenience of herself 
and her child. 

The underwear should be of wool, the thick- 
ness of which must be suited to the season ; for 
this reason she should have three different 
weights : the lightest for summer, the medium 
for spring and autumn, the heaviest for winter. 
Some people prefer for underwear the so-called 
natural wool, others choose a mixture of three- 
quarters wool and one-quarter silk or cotton; 
of late a tendency to choose a linen mesh has be- 
gun to make itself felt, and also some "reform- 
ers "have been endeavoring to discredit the use 



36 THE CARE OF THE CHILD IN HEALTH 

of wool and substitute cotton in its place. 
After the whole matter has been thoroughly dis- 
cussed, and there is no necessity for repeating 
all the lengthy details here, a white or gray 
wool, with or without a partial admixture of silk 
or cotton, will be found to give the greatest 
amount of satisfaction. The form of the gar- 
ments should be what is now popularly called 
"union," that is, the shirt and drawers should 
be woven together into one piece. When new 
suits of this pattern cannot be readily obtained, 
the separate garments may be fitted and sewed 
together so that a fair substitute results. In 
this way one can lessen the amount of weight 
that otherwise would hang on the hips and, at 
the same time, slightly decrease the unsightly 
and unnecessarily thick layers of clothing which 
accentuate the outlines of the protuberant abdo- 
men. 

In the matter of underskirts, a rational mod- 
eration must control one's choice. Especially 
must their number be not too great. In ordi- 
nary cases they need at most be no more than 
two, a fairly short flannel and a mediumly long 
muslin one. They must be sufficiently full, 
and, instead of being closed by means of but- 
tons, may be fitted to the changing form by a 



THE PREGNANT WOMAN 37 

broad band to which a draw-string is attached. 
This draw-string should be in two parts, one to 
control the back and the other the front. Both 
should issue from their pockets at the side, 
where they may be tied without making a 
noticeable lump. In place of drawing them 
very tightly and thereby holding them fast, 
the band of the skirt may be supported from 
the waist or corset cover or by straps which 
hang from the shoulders. If additional warmth 
for the lower extremities is desired, it may be 
obtained by equestrian tights made of a knitted 
fabric, which, while being very comfortable, 
are not bulky. The stockings should be suf- 
ficiently warm and must be held up by side 
supporters, and not by garters, which are se- 
cured to the waist instead of by the common 
device of an abdominal band. The corset waist 
is one of the most important garments, and de- 
serves the most careful thought and attention. 
It must be strong, light, pliable; if the seams 
are somewhat heavier than the rest of the gar- 
ment, it will, in spite of the drag of the skirts 
and stocking supporters, keep its shape. Its 
shoulder pieces will hang the weight from the 
shoulders, where it will be least felt. In place 
of this corset waist some women prefer an 



38 THE CAHE OF THE CHILD IN HEALTH 

empire corset, which is so narrow that it makes 
no pressure on the abdomen, but supports the 
breasts sufficiently well. If such a corset is 
worn, the waist may be somewhat lighter than 
the usual corset waist and somewhat heavier 
than the ordinary corset cover; for one must 
remember that the empire corset is not designed 
to support either skirts or stockings, which, 
therefore, must be fastened to the waist. The 
ordinary corset should, without the slightest 
hesitation, be laid aside for the period of preg- 
nancy and lactation. I do not care to begin a 
discussion of corsets for ordinary occasions, for 
most women under such circumstances will per- 
sist in using them without regard for their 
unhygienic influences. Although no competent 
observer doubts that they may and do bring 
about harmful results, nevertheless, as long as 
they help to improve appearances and make 
dresses set better, they will in all likelihood 
continue to be worn. But when a woman is 
pregnant, a further and vastly weightier factor 
comes into the equation — the future welfare of 
her child. The question ceases to be a merely 
academic one of hygiene or aesthetics, but comes 
to represent a modified degree of physical and 
mental development ; or, stated differently, the 



THE PKEGNANT WOMAN 39 

moral, intellectual, and material efficiency in 
the child's various future spheres of activity. 
It is the same idea that applies to all the details 
of preparation for his birth, and the effort to 
free him from as many disabilities as possible. 
The only difference is one of degree ; no matter 
what may be the divergence of opinion about 
other details, everybody who is familiar with 
the subject believes that at this time the ordi- 
nary corset should be laid aside, for the inter- 
visceral pressure and the restricted opportunities 
for free movement are facts of radical impor- 
tance. The usual excuse that the woman's back 
needs the support of a corset, is not sufficient; 
for a strong waist or the comparatively harm- 
less empire corset will give enough support. 
At the same time, a much better plan would be 
to exercise the weakened muscles of the back, 
and thus increase their strength to such a point 
that artificial support is not needed. 

The outer dress and the methods of designing 
it so that it will best conceal the necessary 
deformities are commonly matters of supreme 
importance to the usual woman, and rightly so. 
For at this period of her married life there are 
many occasions when the ordinary peace and 
quiet of the household are disturbed, and human 



40 THE CARE OF THE CHILD IN HEALTH 

nature is often so frail that it will willingly 
suffer inconveniences from a graceful, well- 
gowned w^oman that it would tolerate grudg- 
ingly from one who was dowdy, awkward, or 
unpleasing. At the same time, the necessity 
of frequently altering the size of the skirts or 
of obtaining new ones is apt to make the attempt 
to look as well as possible a somewhat costly 
one. For this reason, if for no other, it is 
advisable to prepare for this period as efficiently 
as possible. The main requirements are to get 
rid of the belt or any horizontal lines about the 
body and to emphasize the vertical lines in the 
costume. For this reason a street dress may be 
made in the empire style, if one desires to have 
separate waist and skirt. The waist should 
be made with a loose, falling front like the 
"fedora" or "matinee" waist. The skirt 
should be cut with all its breadths of equal 
length, and should be full enough to allow of 
being let out as far as may be required. The 
extra length in the front, as well as the back, 
may be hidden in tucks or folds, and as occasion 
demands may be let out. This garment should 
not be closed in the back with buttons or hooks, 
but preferably may be shirred to fit the form by 
two draw-strings, one for the front and the 



THE PREGNANT WOMAN 41 

other for the back, which issue and are fastened 
at the sides. Another good plan is to make 
two side openings to the skirt instead of one 
behind. These plackets should be from twenty 
to twenty-four inches in length. The waist- 
band is to be broad and elastic and msij be in 
separate pieces for the front and back, having 
long ends for tying. When the wearer dons 
the skirt, she ties the long ends of the rear 
waistband in front, and then fastens those of 
the front waistband in the rear. Naturally the 
garment must be made full enough to conform 
to the increasing size. And if it is heavy, it 
may, when so desired, be supported by straps to 
the waist or from the shoulders. A still further 
plan, which I have found to give satisfactory 
results, is to make the skirt full at the waist, 
closing it in the usual manner behind. Over 
the placket a broad single or double box-pleat 
is laid, which must be tacked to the waistband 
above and to the skirt below the placket. As 
the abdomen increases in size, this box-pleat 
may be shifted more and more from its original 
position, so that it fills up the empty space 
between the two sides of the opening. For 
house wear, wrappers which are loose in front 
should be worn ; the back may be given a fair 



42 THE CARE OF THE CHILD IN HEALTH 

degree of grace by means of a watteau fold or 
pleat. 

For walking purposes a sufficiently long cape 
or cloak should always be used, to the rigid 
exclusion of the tight jacket or coat. Not only 
will the general appearance be improved, but 
also an added degree of comfort will be ob- 
tained. Finally, the costume majr be com- 
pleted by the addition of heavj', fairty broad 
shoes that permit of planting the foot comfort- 
ably and strongly upon the ground. The usual 
belief that a light, thin shoe is easier to walk in 
is an undoubted fallacy. Especially is this 
true when the shoe is made on an artificially 
shaped last, with the plain purpose in view of 
making a certain dainty appearance rather than 
giving the protection that wind, weather, and 
the hard condition of the pavements demand. 
A small vamp, a narrow toe, a thin sole, and a 
high heel that is placed too far forward are all 
conditions that make for disability in walking. 
On account of them the foot cannot be planted 
full upon the ground, the muscles of the legs 
and back cannot relax and contract in a normal 
manner, and the weight of the body is not 
properly distributed. As a result the woman 
complains of pains in the back and thighs. She 



THE PREGNANT WOMAN 43 

takes insufficient exercise, and tissue-change 
as well as nutrition is defective. These dis- 
abilities can be removed by wearing a shoe 
that is long and broad enough, that has a 
strong, heavy sole, large enough vamp, and a 
low heel that is placed sufficiently far back to 
distribute the body weight where it can be best 
borne. 

There is one detail of dressing connected 
with walking in bad weather which I consider 
of no little importance. It concerns the use of 
waterproof leggings that must come to or 
above the knee. The exposure and discomfort 
that come with wet skirts are usually sufficient 
to keep indoors a woman who otherwise would 
gladly take her regular exercise in spite of rain, 
snow, or hail. Therefore, in bad or threaten- 
ing weather I always advise my patients to wear 
such leggings, for I know that a prolific source 
of catching cold is thus removed, and that they 
can with impunity face a storm which otherwise 
would be prohibitory. There is nothing essen- 
tially injurious in walking in rain or snow, 
provided that one is properly clothed. On 
the contrary, the brisk glow that follows the 
struggle with the weather is commonly exhil- 
arating. With sufficient protection, with the 



44 THE CARE OF THE CHILD IK HEALTH 

prospect of wet skirts flapping about chilled 
and wet lower limbs removed, the majority of 
women, who otherwise would be mewed up in- 
doors to their undoubted detriment, will gladly 
take their daily walk. 

Another bar to comfort and the taking of exer- 
cise, which is fortunately not very common, is 
a very large, prominent, or pendulous abdomen. 
It will be sufficient to suggest the use of an ab- 
dominal band which goes under and supports 
the abdomen, and closes in the small of the 
back ; it may be supported and held in place by 
straps across the shoulders. Its ends may be 
fairly narrow, but its middle portion must be 
broad and of a hollow shape, which will adjust 
itself accurately to the outline of the body. 
If this device is properly adjusted the wearer 
will obtain enough relief to change a painful 
and laming pregnancy to a comparatively com- 
fortable one. It is by such small details that 
many disadvantages are overcome ; and, in gen- 
eral, one may say that life as a whole is no 
more than a massing of such details, each of 
which is worthy of conscientious attention. In 
the preparation for a child's birth there is a 
paramount opportunity to exhibit fidelity to an 
ideal, thoroughness of preparation, wise fore- 



THE PREGNANT WOMAN 45 

thought, and a broad comprehension of ultimate 
possibilities. 

While the pregnant woman is arranging all 
these details, it will be wise for her to prepare 
for the lying-in. The things which she needs, 
while not numerous or expensive, are too im- 
portant to be neglected. She should have at 
least two or even three agate or china-ware 
basins, and one or two large pitchers or ewers 
for the use of the physician. Also there should 
be a pound carton of absorbent cotton and some 
clean gauze or cheese-cloth with which the nurse 
may make napkins or pads for the mother. The 
cheese-cloth should be washed, dried, and cut 
into pieces about eighteen inches in length by 
twelve inches in breadth. The cotton may be 
cut into pieces about nine inches long, six 
inches wide, and one inch thick. When the 
cheese-cloth is folded about the cotton, one has 
an ideal napkin that is convenient, comfortable, 
and cheap. To insure surgical cleanliness, 
these napkins, as soon as they are made, should 
be packed in a strong piece of muslin or a 
towel, which is then to be securely pinned up, 
placed in an oven, and baked for about twenty 
or thirty minutes. The package should not be 
opened until after the child is born. 



46 THE CARE OF THE CHILD IN HEALTH 

The abdominal binder may be made from one 
or two thicknesses of unbleached muslin; it 
should be large enough to span and overlap 
the woman's girth, while in breadth it should 
extend from a short distance below the breasts 
down to and even below the hips. To secure it 
in place one should have a few large safety-pins. 

The careful woman, in order to protect the 
mattress, will obtain two pieces of rubber 
sheeting, one of which is large enough to cover 
the whole mattress, while the other is no more 
than half as big. The first is to be securely 
fastened all about the edges, but the second is 
to be used loose. Immediately after the child 
has been born, the smaller may be removed, 
while the other prevents any overflow or drip- 
ping of fluid from soiling the mattress. In the 
course of a day, or when the physician thinks it 
safe, the second may likewise be discarded. 

In addition there should be a plentiful supply 
of towels, a baby's bath-tub, which the physician 
may need in resuscitating a partially asphyxi- 
ated child, a piece of narrow, strong tape (which 
is to be sterilized by boiling) for tying the cord, 
a bottle of carbolic acid or tablets of bichloride 
of mercury for making solutions, and a bottle of 
boracic acid solution for washing the baby's eyes. 



CHAPTER III 

THE BABY'S OUTFIT AND NURSERY 

Long before the baby is born, his outfit should 
have been obtained in its entirety. If one waits 
until the pregnancy is about to end, there will 
usually be so much of a hurry in procuring the 
various articles, in struggling with transient 
attacks of indisposition, and making the various 
preparations for the mother's needs, that some 
things may be forgotten or neglected, or in the 
hurry a compromise be made and inferior or less 
convenient garments and utensils be accepted 
than otherwise. One should go about prepar- 
ing the layette as a matter of love and not 
merely of duty or necessity. Into every little 
skirt or band some affection, some wholesome 
aspiration should be put; under such auspices 
care and work lose their tediousness, and every 
hour of labor becomes sanctified as a partial 
preparation for the doing of useful deeds and 
the thinking of wholesome thoughts. 

There are a few general rules which should 
47 



48 THE CAKE OF THE CHILD IN HEALTH 

control the making and the choice of clothing. 
The garments must be warm, light, and entirely 
without harshness. Infants need more warmth 
than adults, and a lack of it depresses their 
physical condition more than one would usually 
suppose. And not only must there be sufficient 
warmth, but, also, it must be evenly distributed. 
A baby whose chest is overloaded and whose 
legs are bare cannot be expected to keep up a 
nicely balanced thermal equilibrium, but, on 
the other hand, is apt to fall into congestive 
disturbances. The fabric of which the gar- 
ments is made must be as soft and bland as 
possible, for the delicacy of a young baby's skin 
is not to be estimated by our mature standards. 
Its delicacy seems at times almost pathological, 
and only by forethought and scrupulous care are 
skin disorders, with their resulting acute suffer- 
ing, avoided. In addition to these fundamental 
requirements, one should remember that a child 
in arms depends for a large part of his exercise 
upon the freedom to move arms and legs at will ; 
therefore his clothes must be free enough to 
avoid constriction and all manner of rigorous 
binding. There must be as few pins used as 
possible, and even the number of buttons and 
buttonholes must be kept down to the minimum 



THE BABY'S OUTFIT AND NURSERY 49 

in order to allow the girth of the garments to 
be adapted to the requirements of growth. 
Their place is well filled by tapes and draw- 
strings, which plainly have many advantages 
and few objectionable features. Lastly, there 
must be a sufficient number and variety of 
garments to allow as frequent changes as the 
requirements of health and convenience de- 
mand. 

A proper outfit for a well-cared-for child 
should contain at the least the following 
articles : — 

1 hamper or bassinet or 2 wrappers, 
basket. 3 coats. 

2 pieces of diapering. 1 shawl. 

3 flannel bands. 2 caps. 

4 shirts. 1 pair of knit tights. 
6 pairs of stockings. 4 bibs. 

2 pairs of "booties." Safety-pins, large and 

4 barrow coats or pin- small, in sufficient 

ning blankets. number. And, lastly, 

4 nightgowns. a box of fine talcum 

4 slips. dusting powder. 

Although this list should not be abbreviated, 
it may be indefinitely enlarged. Not only are 
there many variations in quality, but the num- 



50 THE CARE OF THE CHILD IN HEALTH 

ber of pieces may be increased according to the 
fancy and means of the parents. The main 
advantage of an increased quantity, outside of 
reasons of luxury, is the smaller number of 
washings through which each piece must go, 
and the consequently lessened amount of 
shrinkage and injury that necessarily follows. 
I have made no attempt to mention all the dif- 
ferent varieties of garments because such detail 
is unnecessary and would, in addition, create 
the impression that many more articles are 
required than are really essential. Moderation 
in providing the layette is by all means desir- 
able, since it may have much to do with fixing 
the standard according to which the dressing of 
the child will be gauged for years to come. 
The mother should keep before her eyes the fact 
that the child, much sooner than she is apt to 
fancy, absorbs ideas of station and scale of liv- 
ing, and that the habit of luxury is more easily 
formed than discarded. She must recognize 
frankly and definitely her present and probable 
future economical scope, and as a matter of 
convenience keep well within reasonable limits. 
For such reasons, as well as the equally im- 
portant one of good taste, she should try to 
make the layette reasonably inexpensive, good 



THE BABY'S OUTFIT AND NUBSERY 51 

in qualitj', not overburdened with ornamenta- 
tion, and frankly serviceable. 

One of the first articles which may be obtained 
is a hamper or bassinet. One of liberal size is 
to be recommended, and preferably should have 
one or more portable trays ; if it rests upon cas- 
tors it can be so easily moved about that its use- 
fulness is materially enhanced. Such a hamper 
has many advantages over the ordinary dressing 
basket, since it can contain the whole outfit, 
and thus saves much time that would be wasted 
in going to and fro in search of the various gar- 
ments, while simultaneously it promotes habits 
of neatness and order. In the hamper each sort 
of clothes should be placed in a certain position 
which, when once found to be practical, must 
be always maintained. It is an excellent plan 
to have the hamper divided horizontally by a 
tray, which not only may separate different 
sorts of articles but also may be of considerable 
use in carrying garments from one place to 
another. 

The material for diapers may be cotton or 
linen, and should be bought by the piece. 
Although the linen is somewhat more expen- 
sive than the cotton, nevertheless it remains so 
much softer and shrinks so much less that its 



52 THE CARE OF THE CHILD IN HEALTH 

advantages overweigh the added cost. The 
diapers may be cut in three sizes, and one 
should progress from the small to the larger as 
the child grows. Convenient sizes are squares 
of sixteen inches, eighteen inches, and twenty- 
four inches. A sufficient quantity of these 
should be provided, because every diaper should 
be thoroughly washed and aired after being used, 
even if it has been no more than dampened ; and 
since it is often possible that the washing can- 
not be promptly done, there must be enough 
clothes to serve for at least two or two and a 
half days. It is wise to provide a covered pail 
to contain the soiled diapers until they can be 
washed, for they should not be thrown with the 
other clothes of the baby or of the rest of the 
family. 

For the first three or four months the child 
should wear an abdominal band, w T hich after 
that time may, unless there are special indi- 
cations for continuing its use, be discarded. 
Three are usually sufficient — one for the 
night, one for the day, and the remaining one 
for change. They are often made of plain 
flannel, but a better and preferable quality is 
made of soft knitted wool, of cashmere, or of 
a mixture of wool and silk. It is rarely neces- 



THE BABY'S OUTFIT AND NURSERY 53 

sary to make them more than six inches wide, 
and one should not commit the mistake of buy- 
ing some of those recently devised which extend 
to the armpits, thus tending to restrict the easy 
play of the chest walls and the contained 
organs. The main reason for putting a band 
on an infant is not entirely for warmth, as is so 
commonly believed, but rather to prevent a 
hernia, or rupture of the navel. The custom of 
using these bands for the whole of the baby's 
first year is to a certain extent a superfluity; 
the main purpose will have been attained at the 
end of two or three months, for after that period 
there is not much danger of an umbilical hernia. 
The little shirts that go next to the skin 
should be supplied in two weights, if the mother 
wishes to get no more than is absolutely neces- 
sarjr, but in three if her means permit a some- 
what greater expenditure. These garments are 
commonly of too small a size, and are not cut 
with the view of their inevitable shrinkage and 
the child's natural growth. They should have 
long sleeves, and instead of being fastened by 
buttons may advantageously be closed with 
tapes. In most cases the buttons are so small 
that after a little use the holes become unduly 
large, and, consequently, the garment is open 



54 THE CARE OF THE CHILD IIST HEALTH 

quite as often as closed. These shirts may be 
made of wool, of a mixture of wool and silk, or 
of cashmere, all of which may be bought in 
various thicknesses from a fairly heavy material 
to the thinnest gauze. They must extend from 
the neck to below the buttocks, so that there is 
no likelihood of their shrinking to or beyond 
the edge of the diaper. It is scarcely necessary 
to say that those used during the day must be 
changed for others at night. The first, after 
being thoroughly aired, may be used on the 
following day. 

In regard to the stockings there are two main 
observations that require attention : they must 
be of the proper weight, and by all means 
should be sufficiently long. The first require- 
ment is easily satisfied, for every well-stocked 
shop has a large enough assortment to allow a 
selection for the different seasons. The ques- 
tion of length is not so easily settled, because 
almost all the stockings that one finds for sale 
are decidedly short. There is no doubt that 
they should extend sufficiently high upon the 
leg to allow of being pinned to the diaper. On 
most children, as usually dressed, they fall 
down about the ankles soon after being drawn 
on, and thereby leave a part of the leg quite 



THE BABY'S OUTFIT AND NURSERY 55 

bare. The natural results of exposure and an 
unequal distribution of heat are not only hard 
to avoid, but also the habit is commonly apt to 
promote congestive disturbances. In addition 
to the stockings, the child, as soon as there is a 
chill in the air, should wear little knitted shoes, 
usually called "booties." These, also, may be 
of two weights and should be changed suffi- 
ciently often to keep them sweet and wholesome. 
To complete the list of underclothes we need 
four or more barrow coats, popularly called 
pinning blankets. In former times these con- 
sisted of a band of variable width joined to a 
long skirt of flannel. It has always been and 
must always be one of the principal garments, 
since it covers most of the body; and, if prop- 
erly made, it gives warmth, does not hinder the 
child's movements, and is easily manipulated. 
To make it a perfect garment its upper portion 
should be changed and lengthened, and its skirt 
shortened. Instead of a band, the form should 
be that of a sleeveless coat, and the skirt should 
extend no lower than a few inches below the 
baby's feet. The habit of clothing an infant 
in very long dresses is a thoroughly unneces- 
sary one ; there is no excuse for it, but, on the 
contrary, there are distinct reasons against it. 



56 THE CARE OF THE CHILD IN HEALTH 

Such skirts are expensive, clumsy, and hard to 
manipulate. They add materially to the 
amount of the weekly wash, and, by their 
weight, especially if heavily embroidered, re- 
strict the child's movements and help to make 
an unnecessary burden for the nurse or mother. 
My objections to them were crystallized about 
six years ago, when I saw a somewhat weak 
infant, of about five months of age, whose leg 
had been broken by the twisting of a weighty, 
heavily worked, and unusually long skirt. 
This accident, to be sure, is a very rare one ; 
but the fact remains that, although rare, it is 
nevertheless possible. The only thing that 
one can urge in justification of long skirts is 
their supposedly decorative effect; but the 
value of even this is very doubtful, and at best 
should not be regarded as important. The 
barrow coat, then, in its abbreviated form and 
fastened in front with tapes instead of buttons, 
makes an easily adjusted, comfortable, and 
well-nigh indispensable garment, which con- 
tributes much to maintaining an even degree 
of heat. In extremely cold weather a modified 
coat containing sleeves may be used. 

Outside of the barrow coat comes the white 
dress, or slip, made of cambric or nainsook. 



THE BABY'S OUTFIT AND NURSERY 57 

No especial directions concerning its form 
need mention, excepting the emphatic sugges- 
tion that it must not be unreasonably long; in 
fact, it should be only long enough to cover the 
barrow coat. The various slips may be made of 
different qualities of material and ornamented 
with the various decorations with which every 
woman is familiar. It is not out of place to 
advise simplicity rather than lavishness in this 
matter; for the baby may look sweet and dainty 
without being made to imitate an overdressed 
lay figure or a gaudy fashion-plate. 

A very useful garment is a warm wrapper, 
made of cashmere, flannel, or any plain material 
which may be tufted. It is designed to wear 
at night, early in the morning, after the bath, 
or whenever the child needs a warm, comfort- 
able dress that may be put on and off with the 
least delay. It must be long enough to cover 
the feet comfortably, large and long in the 
sleeves, and sufficiently snug in the neck to 
prevent gaping. It may be closed at the neck 
and on the chest by ribbons or cords, and about 
the waist may have a heavier cord which will 
keep the free edges from falling apart. Such 
a wrapper may at an emergency be used as an 
auxiliary nightgown, although the ordinary 



58 THE CARE OF THE CHILD IN HEALTH 

night-dresses should be made in different 
weights to suit the seasons. Thus, they may- 
range from cambric and nainsook to flannel and 
knitted goods. They should be large and 
roomy, long enough to keep the feet thoroughly 
warm, and closed with tape or ribbons instead 
of pins or buttons. 

Very little more need be said about the 
layette, excepting a few minor suggestions. 
Thus, one often sees an external diaper made 
of stockinet or other rubber material. The use 
of such an article is to be condemned on the 
ground that it sets a premium on laziness and 
lack of attention, that it is provocative of irri- 
tations and disorders of the skin, and that its 
logical effect resembles closely that of a poul- 
tice. This is easy to understand when one 
considers that a poultice is designed to main- 
tain artificial heat and moisture on a selected 
part of the body, which is exactly what the 
impervious diaper-cover is bound in some de- 
gree to do. There are rare occasions, such as 
when the child appears in a public place, on 
which a contrivance like this may be used for 
an hour or two. But these occasions ought to 
be very rare, and even then with sufficient care 
the child can be kept in an unobjectionable 



THE BABY'S OUTFIT AND NURSERY 59 

condition with no more than his usual clothing. 
Another suggestion may be made concerning 
bibs. The use of these articles is to save the 
front of the slips from being soiled with food 
and saliva. They should, therefore, be made 
of a closely woven material which does not 
readily absorb and hold moisture. A sodden 
bib may possibly be the means of dampening 
and chilling the chest, and thus give rise to a 
bronchitis or other related disorders. A useful 
bib for hand-fed babies may be made by folding 
up its lower margin to form a wide pocket into 
which drippings of food may run and be held. 
Such a bib must naturally be made of an imper- 
vious material, and should be removed shortly 
after feeding has been completed. 

Now that the baby's outfit is completed, one 
should consider the problem of selecting a room 
for the nursery and furnishing it in a comfort- 
able, hygienic, and attractive manner. The 
sunniest room in the house ought to be chosen, 
for babies like flowers need plenty of sunshine 
and air. A southern exposure is to be pre- 
ferred to any other, for under such conditions 
the requirements are most apt to be met. The 
best facilities for ventilation are essential, and, 
at the same time, are not hard to provide. 



60 THE CARE OF THE CHILD IX HEALTH 

Every day the windows must be left open for a 
sufficient time, both in winter and summer, to 
insure the thorough airing of the room. And 
while they are closed the entrance of fresh air 
may be insured by one or more of several 
methods of ventilation. The heating of the 
room should be so devised as to contribute some 
assistance to this end. The method which 
gives the best results is that of a grate fire, 
properly guarded by high, strong fenders. A 
good stove that is heavy enough to prevent 
overturning, especially if it is surrounded by a 
wire guard, is also a very useful means ; at the 
same time it does away with the large amount 
of dust and dirt that a grate fire is bound to 
cause. A Franklin burner also has many 
advantages, especially as it is very clean. The 
most objectionable method is the ordinary steam 
heat, which clearly ought not to be allowed in 
any well-appointed nursery. In the other 
methods the rarefaction of the air caused by 
the heat and the draught of the chimney bring 
a corresponding amount of fresh air into the 
room through the crevices and joints of the 
windows and doors, and thus serves our pur- 
pose more actively than one would suppose. 
A more direct way of ventilation is through 



THE BABY'S OUTFIT AND NTTRSEEY 61 

some device connected with the window. One 
of the simplest and best of these consists of 
lowering the upper sash about six inches and 
filling the open space with a plain piece of 
board. The window is then closed at top and 
bottom, but open in the middle. The cold air 
is directed, by the situation of the opening, to 
the upper part of the room, whence, on account 
of its weight, it gently descends and produces 
no draught. Another way is that of the old- 
time ring ventilator, which is set in a pane of 
glass in any of the windows. This gives the 
minimum of trouble, but it is not so easily con- 
trolled as the first device. There are yet other 
methods, such as the box ventilator, which is 
attached to a permanent opening at the top or 
bottom of the window, and is opened or closed 
by a sliding panel or similar device. By such 
means it is always possible to have pure, fresh 
air in the room; and one must see to it, as a 
prime necessity, that there should never be a 
stuffy, close, or unpleasant atmosphere in this 
most important part of the house. While we 
are working on the windows we may order the 
iron gratings for the lower half, which are de- 
signed to prevent the child from leaning too far 
out or falling to the ground. This prevention 



62 THE CARE OF THE CHILD IIsT HEALTH 

is, naturally, superfluous in the first year of 
life ; but it is well, so long as one is fitting up 
a nursery, to make it complete and thus save 
the trouble of making additions later on. A 
further detail is the supplying of two sets of 
roller shades or blinds for the windows, one of 
a light color and the other of a dark blue or 
dark green holland. The latter is to be used 
in darkening the room at whatever time of day 
the bahy may be sleeping. As will be seen 
later on, this is a matter of some importance. 

The floor may be made of hard wood and cov- 
ered with skin rugs, or of the ordinary soft pine 
painted and similarly covered. The rugs are 
designed to give warmth even more than for 
their decorative effect. Their greater cleanli- 
ness is the reason for preferring them over car- 
pets, and, therefore, they must not be so large 
as to render an easy and frequent removal into 
the air difficult. Fur rugs make a desirable 
covering for parts of the floor, especially as they 
serve, when the child is old enough to like 
stories, as a basis for all sorts of tales concern- 
ing animals, strange lands, and adventures. 
Some able mothers prefer a covering of fine 
Japanese matting in place of the polished or 
painted floor, on the ground of its greater 



THE BABY'S OUTFIT AND NURSERY 63 

warmth, greater sureness for the foot, and 
almost equal ease in being kept clean. If a 
few mats or rugs are strewn here and there, its 
attractiveness is considerably increased. The 
covering of the side walls and ceiling deserve 
the expenditure of thought and taste, for they 
have much to do with deciding the character of 
the room and the first formative impression upon 
the child's eyes. Some good, attractive, ele- 
mental color should be selected as the main 
note in the decoration and should be logically 
and tastefully carried out in the wall, ceiling, 
and even the furniture. 

But before the decorations are begun one 
should rehearse clearly what sanitary demands 
must be answered in this part of the room. 
These are scrupulous cleanliness, lack of incli- 
nation to acquire disease germs as well as dirt, 
and ease in renovation. Obviously, the best 
surface for such purposes is a smooth, hard, 
and waterproof one. Therefore, the walls and 
ceiling should be covered with an oil color, 
with or without a coat of varnish, or with a 
paper which may be varnished. For this pur- 
pose one can now buy some very desirable 
papers with an attractive pattern showing chil- 
dren at play, animals sporting and at rest, or 



64 THE CARE OF THE CHILD IN HEALTH 

pretty sketches of landscape. Some are even 
made with a hard, glossy finish which permits 
washing. This is one of the essential features 
of every nook and cranny of a well-appointed 
nursery, for by this means we are able to dimin- 
ish or prevent the likelihood of various sick- 
nesses. When the wall-paper is of a decorative, 
thickly covered pattern, little or no additional 
ornamentation is needed from pictures ; but if 
pictures are hung up, they must likewise be of 
such a nature that they may with impunity be 
washed, or of so little value that on proper pro- 
vocation they may be destroyed. These articles 
are of secondary importance, and with a suf- 
ficiently decorative paper need be supplied in 
small quantities or not at all. The main ob- 
jection to them lies in the possibility which 
they furnish of collecting dust and harboring 
germs of disease and fermentation. A similar 
objection may be made against curtains and 
portidres, the use of which has the additional 
objection of increasing the danger of fire. But 
if they are a part of the furnishing, they must 
not be placed in close proximity to a gas-jet, a 
stove, or an open fire of any sort. 

The furniture must follow the same rule of 
sanitary impeccability. Every piece of it, 



THE BABY'S OUTFIT AND NURSERY 65 

besides being light and strong, must offer little 
opposition to being scrubbed or cleansed. For 
this purpose the use of enamel paints in any 
desired colors is highly to be recommended. 
Thus the chairs should be of wood or wicker, 
painted white or any other light color ; and if 
upholstery is desired it may be supplied in the 
form of cushions, which are to be kept in place 
by ribbons or tapes. If a sofa or lounge is to 
have a place in the room, it should be of simi- 
lar material and similarly covered. The cush- 
ions should be covered with a waterproof fabric, 
with or without an additional slip cover of 
chintz, cretonne, denim, or similar wash goods. 
In this way one can insure the maximum of 
comfort, convenience, and cleanliness with the 
minimum of expense, unnecessary work, and 
danger of harboring infection. This general 
plan need not be confined to the pieces here 
mentioned, but to every article that is sus- 
ceptible of such treatment. 

The other essentials are a bath-tub, a wash- 
basin, a toilet chair, a screen, and an ice-box. 
The bath-tub must be small enough to be moved 
about with ease, as well as to occupy no ex- 
travagant amount of space when not in use. 
One of the best models is made of a large pouch 



66 THE CARE OF THE CHILD IN HEALTH 

of rubber cloth suspended from a rectangular 
wooden frame, which is supported upon col- 
lapsible legs. This tub is inexpensive, easily 
handled, and sufficiently high to enable the 
mother, while sitting comfortably on a chair, 
to give the bath quickly and thoroughly. In 
this respect it has a decided advantage over the 
ordinary type of metal tub, which is so low that 
it makes the bathing of the child a matter of 
considerable discomfort for the mother or nurse. 
Of course, it can be raised by means of a chair 
or a bench ; but such a device is really a clumsy 
one. In those favored houses where there is a 
well-heated bath-room attached to the nursery, 
the large bath-tub may be covered in part by a 
temporary wooden grating upon which the 
baby's tub may rest. This prevents the dis- 
comfort of the low position, it does away with 
the danger of splashing the floor, rugs, and 
furniture with water, and, if the small tub is 
filled by means of rubber pipes attached to the 
faucets, requires the least trouble in prepara- 
tion. But as in most cases the bath-room is 
not connected with the nursery and, in addi- 
tion, is almost always colder in winter than the 
other rooms in the house, it generally cannot be 
used for this purpose. 



THE BABY'S OUTFIT AND NURSERY 67 

The wash-basin is used for all washings other 
than full baths ; it may be in the form of the 
ordinary basin, but a better type is where it is 
divided by a partition which makes two com- 
partments, one for hot and the other for cold 
water. The partition should have a handle 
attached to its upper margin by which the basin 
may be carried with ease. The toilet chair 
should be made of painted wood or wicker, so 
that it cannot be injured by frequent and 
thorough scrubbings. It should form a part of 
the first outfit, for its use, as will be later on 
shown, need not be deferred as long as the 
present custom demands. The screen should 
be a serviceable article, not designed for dec- 
oration alone, and will be found very useful in 
shielding the child while he is asleep, being 
bathed, or being dressed. It also should be 
made of waterproof material which permits of 
as frequent washing as scrupulous cleanliness 
demands ; it must be strong, light, and not too 
large to render its constant handling in any 
way burdensome. The rule must be made and 
steadfastly enforced against using the screen, 
or, in fact, any other piece of furniture in the 
nursery, for the drying of soiled or damp diapers 
and other garments. Such a habit is to be 



68 THE CARE OF THE CHILD IN HEALTH 

heartily discouraged, for it tends to permit or 
sanction laziness and lack of cleanliness, which 
are often followed by skin diseases or other 
troubles of the child's buttocks and body in 
general. Whenever any of the garments has 
been in any way soiled, no matter how slight 
the soiling may be, it should be thoroughly 
washed and rinsed in the kitchen or laundry, 
dried, aired, and ironed before being used. It 
is so easy to disregard this rule, the tempta- 
tions — especially to a careless nurse — are so 
common, and the consequences may be so much 
out of proportion to the seemingly trivial nature 
of the offence, that no exceptions should be 
allowed. 

The ice-box is meant to hold the unused food 
of a hand-fed infant, or that of a somewhat older 
child who is yet too young to be fed on the 
varied diet that comes with later years. It may 
be made of tin or zinc, and must be so light 
that its weight offers no objection to frequent 
washings and airings. Its partitions must be 
removable, for at least once a week they should 
be taken out, and the whole structure thoroughly 
scrubbed and allowed to dry in the sunshine. 
An ice-box that is not surgically clean is a 
fruitful source of the "spoiling" or fermenta- 



THE BABY'S OUTFIT AND NURSERY 69 

tion of food; and if such fermentation did not 
exist, a large proportion of the diseases of in- 
fancy would be unknown. The conscientious 
observance of these details, and others like 
them, is the very basis of an uneventful and 
successful conduct of the infant's career. The 
importance of the matter may be estimated 
from the fact that the child during this period 
is going through one of the crises of his life, 
that the formative character of the first months 
has much to say about what he is later on 
going to be, and that efficient administration 
of all the minutiae of babyhood should — in 
order to form a correct conception of their 
value — be translated into forms of the thoughts 
and deeds, the physical and mental state, of the 
future man and woman, as well as those who are 
dependent upon them. The man who said that 
he would rather write the songs of a people than 
make their laws, had enough imagination to see 
beyond the border-line of facts; but his pro- 
jected empire would have been vastly increased 
if he could have made a choice of the customs 
and habits of young children. 



CHAPTER IV 



FEEDING 



The problem of feeding a child is not a par- 
ticularly difficult one if the mother understands 
clearly what the baby needs and how to make 
the various changes and modifications that a 
normal development necessarily entails. Most 
of all it is important to grasp a few fundamental 
principles which are at the basis of nutrition. 
This question of nutrition is one of the main 
subjects of thought and effort that an intelligent 
mother has to reckon with; it constantly re- 
appears in one form or another, touching upon 
and involving one interest after the other. In 
the last analysis it stands for most of what we 
want a child to be — the personification of vigor 
and strength of body united with vigor and 
strength of mind. There is little doubt that 
mental action is closely bound up with physical 
competency, in the same way that we know 
quite positively that disturbed action of the body 
is usually, if not always, associated with dis- 

70 



FEEDING 71 

torted function of the mind. These two factors 
stand to each other in the relation of comple- 
mentary parts of an intricate machine and their 
interdependence is as inevitable as it is inti- 
mate. Thus the fact of feeding a child comes 
to have a higher significance than merely satis- 
fying his hunger; we may go even farther, and 
say that the feeding of a child means much more 
than the feeding of an adult. For in the latter 
the desired object is merely to maintain the set- 
tled equilibrium of the matured organism, to 
continue a settled condition. In the former. 
however, it has the additional burden of sup- 
plying new elements of growth in order to 
change an unstable to a stable equilibrium, of 
making something exist where formerlv it did 
not exist, of changing tissue to so great a de- 
gree as to be equivalent to a difference in kind. 
The feeding of an infant should be restricted 
to the mother's milk. If this natural food is 
sufficient in quantity and quality it forms the 
ideal nourishment. All the needs of the or- 
ganism are fulfilled, at very little danger of the 
food's possessing an improper composition or 
being contaminated with germ life or impurities. 
Xaturally this is a matter of paramount impor- 
tance and demonstrates how perfectly nature 



72 THE CARE OF THE CHILD IN HEALTH 

adapts means to ends. In addition, however, 
there is another factor of salient importance 
which makes the nursing of the child by the 
mother a matter of the greatest value; for the 
exceedingly intimate relations tend to promote 
the bond between parent and child, the mother 
with every nursing period recognizes that the 
little one is a very part of herself, and that a 
very part of herself is contributing to make and 
maintain his life. The resulting sympathy is 
and must be exquisitely intimate and gives the 
possibility of insight into the child's physical 
and mental being which otherwise cannot be 
obtained. As far as the baby is concerned, who 
shall say that he is not mightily influenced by 
the fluid which means life to him, by the won- 
derfully close relations with the one who nurses 
him, by the unconscious absorption of char- 
acteristics which make up the family person- 
ality! Such influences are at the bottom of 
the belief that blood is thicker than water and 
to their cohesive force the tremendous power 
of child- and parent-relationship is due. The 
woman who suckles her baby enjoys a great 
opportunity, for which she ought to be deeply 
grateful, to assist in moulding him into the form 
that he ultimately will assume; and nothing but 



FEEDING 73 

absolute necessity should induce her to throw 
away this great privilege. 

In some cases, however, on account of physi- 
cal incompetency or sickness, she is compelled 
to forego her privilege and duty. When this 
necessity has been demonstrated as a fact, she 
should promptly acquiesce in it, as she should in 
any other misfortune. Once that the milk has 
been shown to be too deficient for its purpose, 
the child should be weaned and a substitute food 
be given in its place. There should be no hesi- 
tation or compromise in this, nor should the baby 
be fed in part on an artificial food and in part 
on the breast. For if the mother's milk is 
markedly imperfect, it continues so to be, 
whether an artificial food is or is not added; and 
the result is apt to be a continued state of 
imperfect nutrition. This is apt to be the case 
where the mother is of an overnervous, hys- 
terical disposition, if she is markedly unhappy, if 
she is thoroughly exhausted, or if she regulates 
the factors of rest, diet, exercise, and relaxation 
so poorly that a normal secretion of milk is out 
of the question. Here the quality of the milk 
may be so bad or it may vary so widely from 
day to day that a gradual but real starvation 
must necessarily be present. 



74 THE CARE OF THE CHILD IN HEALTH 

An exception should be made of those cases, 
which are to be distinguished by the physician, 
where the error in the constitution of the milk 
is merely temporary, or due to some passing 
condition in the mother. Thus the total quan- 
tity may be too small, although the quality is 
good; in this case an increase in the amount of 
liquids in her diet will often remedy the fault. 
In other cases the quantity may be too great, 
but it can be reduced by the opposite means of 
reducing the amount of fluids consumed. If 
the milk is too watery, its relative amount of 
solids may be increased by taking less exercise, 
decreasing the quantity of fluids consumed and 
shortening the intervals between the feedings. 
If the milk is not watery enough, a desirable 
effect may be produced by reversing these sug- 
gestions. The amount of cream or fat in it may 
be increased by adding more meat to the diet, 
and lessened by eating less meat. The proteids 
are increased by a more sedentary life, and 
decreased by adding largely to the amount of 
exercise. These rules are naturally meant to 
apply to cases of minor disturbances, and, if 
they are carried out with the aid of a competent 
physician, will undoubtedly be of considerable 
use. In general, however, the wisest course for 



FEEDING 75 

a nursing mother to pursue is to eat regularly 
and liberally of a sensible diet that includes 
soups, meats, fresh vegetables, eggs, and meats; 
she should avoid pastries, hot breads, con- 
diments, and articles that her ordinary expe- 
rience and knowledge have demonstrated to be 
indigestible. Milk especially should have an 
important place in the daily dietary, and in ad- 
dition may be the basis of a light meal that 
should be taken before retiring for the night. 
In many ways it is superior to the ordinary 
alcoholic drinks, whose value as milk producers 
is apt to be overestimated. 

When, in spite of well-directed efforts to 
conform to a normal and rational plan of diet, 
exercise, and self-control, the supply of milk is 
unsatisfactory, a choice must be made between 
hand-feeding and a wet-nurse. Theoretically 
the latter has much to recommend her, but prac- 
tically her selection has many weighty objec- 
tions. In most cases she is the victim of 
unhappiness, ill-treatment, or viciousness ; very 
often she comes from a decidedly unfavorable 
class of society; her habits — either secret or 
avowed — are commonly bad, and the change 
from comparative poverty to the luxury that is 
lavished on her for the sake of her foster-child 



76 THE CARE OF THE CHILD IN HEALTH 

is apt to be demoralizing. Too commonly one 
sees such a woman — ignorant, lazy, and wrong- 
headed — elevate herself into the position of a 
petty tyrant, who domineers over the whole 
household by means of her influence with the 
child, and the common fear of interfering with 
his food supply. The position naturally lends 
itself to the possibility of abuses, and the 
temptation for an undisciplined woman to take 
advantage of it is certainly strong. Besides 
all this, the psychical effects of the intimate 
relation are of undoubted, even if indefinite, 
importance, and offer a constant menace to the 
mother's peace of mind. Of course, if an 
unobjectionable person could be obtained, one 
who was between twenty and thirty years of 
age, who was quite healthy, with an entirely 
good milk supply, whose habits were unim- 
peachable, who had had a previous child, 
whose temper was even and well controlled, 
whose disposition was peaceful and affection- 
ate, and whose outside connections were not 
embarrassing, the problem of substitute feeding 
would offer less difficulty than is usually 
encountered. 

Practically, the only other method that re- 
mains, if we discard the wet-nurse, is the use of 



FEEDING 77 

ordinary cow's milk which has been sufficiently 
modified to make it approximate as closely as 
possible to mother's milk. Occasionally an 
attempt is made to use goat's milk or ass's milk; 
but the difficulty in obtaining it is so great, the 
supply is necessarily so limited (one ass giv- 
ing no more than one-half pint to one pint per 
day), and the composition would nevertheless 
so clearly need modification, that we can, as a 
rule, get more satisfactory results from good, 
pure, cow's milk. Having decided that this is 
to be the basis of the food, one is then con- 
fronted by the vexing question of boiling it or 
leaving it raw, of sterilizing, pasteurizing, or 
peptonizing it. The original objection to raw 
milk was not at all a chemical, but merely a 
hygienic one. Physicians came to know that 
it often served as the carrier of disease germs. 
Thus, tuberculosis, typhoid fever, diphtheria, 
and other sicknesses have spread, so that almost 
all the disorders that afflict cows, the farm- 
hands, and the milk handlers have been, at one 
time or another, attributed to the use of the 
unboiled fluid. Moreover, if the cans and pails 
are not kept scrupulously clean, various degrees 
of fermentation occur that give rise to diarrhceal 
troubles and low forms of poisoning. In order 



78 THE CARE OF THE CHILD IN HEALTH 

to avoid such contingencies, the practice of 
boiling the milk in order to kill the germs came 
into use. Before a long time passed, physicians 
began to notice that while the amount of germ 
disease decreased, the number of cases of mal- 
nutrition decidedly increased; and, promptly 
enough, the cause was traced to the alteration 
in the character of the milk produced by the 
boiling. This alteration consisted of coagula- 
tion and increased difficulty in digesting the 
albumin, changes in the milk-sugar, and 
changed relations of the emulsion in which the 
fats were suspended. The result was, that 
children were taking a food that was materially 
different from what it originally was supposed 
to be, and on account of which they ceased to 
thrive. 

In order to do away with these evil effects, 
but at the same time to kill the germs, the 
process of sterilization was devised. This con- 
sists of subjecting the milk to a temperature of 
212 ° F. for a comparatively long time. Most 
germs were thus destroyed, while it was hoped 
that the milk would nevertheless be good. 
Extended experience showed that a sterile milk 
could disappoint our expectations of its nour- 
ishing powers, and that many children who had 



FEEDING 79 

been carefully fed in this way became afflicted 
with scurvy as well as less pronounced forms of 
malnutrition. Then a further change was made 
by reducing the amount of heat to 167° F. and 
cutting down the length of exposure to it ; this 
process, called pasteurization, was intended to 
undo the evils of sterilization, as sterilization 
was intended to reform those of boiling. Unfor- 
tunately there are observers who find bad results 
from the use of pasteurized milk, and who are 
therefore forced to go back to sterilization, or to 
strike at the root of the whole trouble by insist- 
ing upon an uncontaminated milk, which they 
refuse to alter by heat. There is no doubt that 
such milk has marked advantages over all 
others, but until of late it could not be had. 
In recent times, however, state inspection of 
cattle has done much to clear tuberculosis from 
the herds, and there are a number of dairy-farms 
where the animals, their stalls, the utensils, the 
clothes and the hands of the milkers and milk 
handlers are kept so clean that the danger 
of infection is reduced to a minimum. In 
addition, also, to such care in collecting and 
handling it, the milk should before it leaves 
the farm be poured into bottles, which then are 
to be packed in ice or in refrigerated compart- 



80 THE CARE OF THE CHILD IN HEALTH 

ments, and thus kept at a low temperature until 
it is delivered to the consumer. The essence 
of the precautions is to have milk from a 
healthy, well-fed cow or herd of cows, w T hich 
has not been allowed to be contaminated by im- 
pure contact or air. 

But even if the milk is quite pure, it is not, 
on account of its chemical composition, ready 
for use. Both cow's milk and human milk 
contain the same elements, but not in the same 
relative proportions. These elements we know 
as proteids, or albuminous matter, fats (com- 
monly called cream), sugar, mineral salts, and 
water. An analysis of them shows their relation 
clearly : — 

Human milk. Cow's milk. 

Fat 3.50% 3.50% 

Milk-sugar 6.50 4.30 

Proteids 1.50 4.00 

Mineral salts 0.15 0.70 

Water 88.35 87.00 

The main difference, as we can easily see, lies 
in the proportion of proteids ; the smaller varia- 
tions in the sugar and salts are of no great 
importance. And not only is the percentage of 
proteids greater in cow's milk, but also the 
character of the material is different. Before it 
can be digested, it becomes coagulated by the 






FEEDING 81 

acid and the gastric juice into a comparatively- 
hard mass; in human milk, however, it is 
changed into fine, soft flakes, which, on account 
of their form, offer a larger surface to the digest- 
ing agents, and thus are easily and quickly 
changed into the ultimate condition in which 
such material is absorbed into the circulation. 
The main problem, then, has always been to 
modify the milk in such a way that the proteids 
would be reduced by one-half or more, while the 
other constituents remained practically the 
same. It was for this purpose that "milk 
laboratories " have been established in some of 
the large Eastern cities, whose business it is to 
prepare milk for infants according to the formula 
which the physician submits to them. While 
this is the easiest way to obtain a properly 
modified milk, it is, unfortunately, out of the 
reach of most families for the two good reasons 
of locality and expense. The great need is 
to spread the knowledge of how to modify the 
milk at home without too much trouble and 
expense. 

Although it is not feasible to give all the 
directions necessary for modifying milk to suit 
the various needs of children whose digestive 
systems are in an abnormal condition, it is dis- 



82 THE CARE OF THE CHILD IN HEALTH 

tinctly desirable to describe an easy method of 
preparing a suitable milk for a healthy child. 
To do this, one needs nothing more than the 
cream of good milk and a definite solution of 
milk-sugar. If a bottle of milk be placed on 
the ice for five hours, the cream will rise in such 
an amount as to constitute 8% of the whole; if 
it is allowed to stand six hours, it will consti- 
tute 12%. The cream, after having been 
allowed to rise, should be decanted off into a 
clean bottle, and used according to the follow- 
ing directions. The milk-sugar may be made 
in a solution with boiled or distilled water by 
any druggist or at home. In the following 
mixtures a 7% sugar solution and a 10% sugar 
solution are employed. For a child of two 
months or less, we may prepare a mixture con- 
taining the small proteid percentage which his 
age calls for in the following proportion : — 

Fat 3% 

Sugar 6 

Proteids 1 

To make such a mixture one should use one 
part of the 12% cream and three parts of a 7% 
sugar solution. Mix well. 

For a child from three months to one year of 



FEEDING 83 

age, one may increase the amount of proteids, 
as in this formula : — 

Fat 3.5% 

Sugar 6.0 

Proteids 1.2 

In making this mixture, one should take one 
part of the 12% cream and two and one-half 
parts of a 7% sugar solution. This, likewise, 
must be well mixed. 

For the two months succeeding the first year, 
the proteids may be yet further increased, as : — 

Fat 4% 

Sugar 7 

Proteids . . 2 

This is made by mixing equal parts of the 
8% cream and a 10% sugar solution. 

A sufficient quantity of the desired mixture 
may be made to serve for twenty-four hours. 
It should immediately be poured into as many 
bottles as there are feedings, each bottle should 
be corked with a plug of aseptic absorbent cot- 
ton, and all should then be put on ice. Each 
one before being used should be warmed by being 
immersed in hot water, the cotton plug removed, 
the nipple should then be adjusted, and the 
preparations are thus completed. If any milk 
remains in a bottle, it must under no circum- 



84 THE CAKE OF THE CHILD IN HEALTH 

stances be used again, but should immediately 
be thrown away. As one can easily see, it is 
not hard to know exactly how much to prepare ; 
therefore there could then be no waste, and the 
work will be done at one time and quickly. 
All this is easily determined by making out a 
plan of the number of feedings per day, the 
time of each, the quantity of each, and the total 
quantity, as follows : — 



Scheme for feeding an Infant, with Intervals and 
Quantities 





INTERVALS 
BETWEEN 
FEEDINGS 


AMOUNT IN 
EACH BOTTLE 


NUMBER OF 
FEEDINGS 
PER DAY 


TOTAL 
AMOUNT 


1 week 


2 hours 


1 ounce 


10 


10 ounces 


2 weeks 


2 " 


lh ounces 


10 


15 " 


3 " 


2 " 


2 " 


10 


20 " 


2 months 


2 " 


21 " 


10 


25 " 


2| " 


2\ " 


3 " 


9 


27 " 


3 " 


2| " 


Sh " 


8 


28 " 


4 " 


3 M 


4J " 


7 


29 " 


5 " 


3 " 


41 " 


7 


31* " 


6 " 


3 " 


51 " 


6 


33 " 


7 " 


3 " 


6| " 


6 


39 " 


8 " 


3| " 


7 


6 


42 " 


9 " 


Sh " 


7 


6 


42 w 


10 " 


31 " 


81 " 


5 


42| " 


11 " 


3i " 


81 " 


5 


44 <{ 


12 " 


3i « 


9 


5 


45 " 


13 and 14 mo. 


4 " 


10 


5 


50 " 







FEEDING 85 

Let us take a few examples and see how easily 
the work is done. Suppose we wish to prepare 
the food for a baby six days old. We need 
ten ounces of milk, which is made up of 

one part of 12% cream, or , 2J oz. 

and three parts of 7% sugar solution, or .... 7 J oz. 

Total, 10 oz. 

As for this time of life there should be ten 
feedings per day, the mother had best have the 
ten bottles ready when the mixture is made; 
they may all be filled at one time, stoppered, 
and put on the ice until needed. 

Again, suppose the child is six months of age. 
For this period there should be thirty-three 
ounces of food, which would be composed of 

one part of 12% cream, or 9J oz. 

and two and one-half parts of 7% sugar solution, 

or 23f oz. 



Total (approximate), 33 cz. 

Since there are to be six feedings, six bottles 
must be prepared, each containing five and 
one-half ounces. 

Again, suppose we want to prepare the milk 
for a baby of twelve months. The quantity 
is to be forty-five ounces. We then need 



86 THE CARE OF THE CHILD IN HEALTH 

one part of the 8% cream, or 22J oz. 

add one part of a 10% sugar solution, or . . . 22J oz. 

Total, 45 oz. 

This quantity is to be divided into five 
bottles, each of which contains nine ounces. 
As in the other cases, all the bottles are to be 
stoppered with aseptic cotton, and placed upon 
ice until used. 

One more detail may be required in some 
cases: the normal reaction of human milk is 
slightly alkaline. Since cow's milk is fre- 
quently neutral or slightly acid, we may add a 
small quantity of lime-water to make the desired 
change. The necessity of the change is ascer- 
tained by dipping a small piece of red litmus 
paper, which any druggist or chemist will 
supply, in the cow's milk and finding that it 
is turned somewhat blue. A neutral reaction 
gives no change at all, while an alkaline milk 
will change blue litmus paper red. If the milk 
on several testings has shown itself acid or 
neutral, the lime-water may regularly be added 
in the proportion of from 3% to 5% to the water 
in which the milk-sugar is to be dissolved. 

A most important detail of hand feeding is 
the care of the bottles and nipples. If they are 
not scrupulously clean, particles of milk adhere 



FEEDING 87 

to them, decompose, and give rise to a large 
number of gastric and intestinal diseases, such 
as vomiting, diarrhoeas, and summer complaint. 
In most cases such disorders ought not to exist, 
and the child who suffers frequently from them 
has a just cause of complaint against the mother. 
Such cleanliness is insured by scrubbing, boil- 
ing, and rinsing the bottles, nipples, and all the 
utensils which are used in the daily preparation 
of the milk. Each bottle as soon as it is used 
should be thoroughly washed with soap and 
water and a bottle cleaner ; it ought then to be 
boiled for from twenty to thirty minutes, and, 
finally, put in a solution of borax until it is 
wanted the next morning. Before being used, 
it should be thoroughly rinsed with hot water. 
The nipples, as soon as a feeding has ended, 
should be drawn on to a finger, scrubbed with 
a brush, soap, and water; they may then be 
turned inside out, replaced on the finger, and 
again scrubbed. They may, as the next step, be 
thoroughly washed in hot water, and, finally, be 
thrown in the borax solution until used again, 
when they must be well rinsed. These nipples, 
in order to be easily manipulated, should have a 
plain, conical shape, somewhat like a dunce's 
cap, and should be made of plain black rubber, 



88 THE CARE OF THE CHILD IN HEALTH 

with an aperture that is not too large. The 
bottle should preferably be tubular in form, 
with gradations which mark the ounces and 
half ounces blown into the side. All attempts 
at decreasing the labor involved in feeding the 
child, by air vents in the nipple, rubber tubes 
connecting the nipple and bottle, and variation 
in the shape of the bottle on account of which it 
need not be held, are bad, and ought to be dis- 
couraged. Such devices make surgical cleanli- 
ness impossible, they promote laziness, diminish 
the rightful attention which the child deserves 
and demands, and serve as prolific sources of 
serious sickness. The feeding of a child is 
important enough to call for the nurse's undi- 
vided attention, and anything which interferes 
with this duty must sooner or later have vi- 
cious results. During the process the child 
should be held in the arms, and the bottle 
must be so inclined that the nipple is almost 
full; in this manner the flow of milk can easily 
be regulated to suit the baby's capacity to 
drink, while at the same time the possibility 
of sucking on an empty nipple is obviated. 
The habit of permitting a child to take a frac- 
tion of his food, to sleep or play or become 
irritated by a bad position, and then to begin 



FEEDING 89 

nursing again after the milk has become more 
or less chilled and stale, must not be tolerated. 

Yet another method of feeding is that which 
does away entirely with bottles and nipples, 
and substitutes in their place a cup and tea- 
spoon. This change has much to recommend 
it, for it does away with the labor of keeping 
the bottles and nipples clean, and simultan- 
eously diminishes the danger of infection of 
the gastro-intestinal track. Likewise it pre- 
vents too rapid nursing, as well as "wind 
sucking"; the feeding is completed at one 
sitting, and the child's habits in general are 
better kept under control. One of its main 
advantages is the ease with which it allows 
weaning to be accomplished. In this period of 
the child's life the main difficulty lies in replac- 
ing the bottle with a spoon, and everybody 
knows the disturbances which are apt to result. 
Under the circumstances suggested above, these 
disturbances would not exist, and the baby 
would go from one stage of his youthful career 
to the succeeding with almost no evidences of 
struggle. 

Something ought to be said concerning the 
use of the proprietary foods which are so exten- 
sively advertised and widely employed in all 



90 THE CARE OF THE CHILD IN HEALTH 

classes of society. If one wishes to make a 
general statement, one is quite safe in con- 
demning them all along the line. They really 
have no good reason for existence — outside of 
the purely commercial one which gives profit- 
able employment to their manufacturers. The 
artificial food has never been made which can 
adequately take the place of pure, fresh milk, 
properly modified. The fact that hundreds of 
children have grown and thrived upon them has 
little to do with the question ; for many children 
are so vigorous that they will thrive upon all 
manner of food-stuffs which we know are meant 
for older stomachs. As I heard a bright woman 
once remark, " There are some babies that you 
can't kill." In regard to such children the 
question is not how well the little ones develop 
on this or that food, but rather, how much 
better they would have developed on a properly 
modified milk. To such origins we can trace a 
large proportion of all cases of rickets, infantile 
scurvy, and a seemingly endless series of obsti- 
nate cases of malnutrition and malassimilation. 
The various foods may be divided into certain 
classes, whose methods of manufacture are not 
radically dissimilar. Thus, the Liebig foods, 
such as Horlick's Food, Mellin's Food, Malted 



FEEDING 91 

Milk, and Hawley's Food, represent a combina- 
tion of flours which have been treated with 
diastase until the starch is changed into forms 
of sugar, called maltose and dextrine. The 
milk foods, such as Nestle 's, the various Swiss 
foods, and Gerber's Food, represent condensed 
milk which has been sweetened and supple- 
mented with dextrinized flour. The farinaceous 
foods, such as Ridge's Food, Imperial Granum, 
Robinson's Patent Barley, and Hubbell's Pre- 
pared Wheat, usually consist of a combination 
of flours, the starch of which has been partly 
converted into sugar. Carnrick's Soluble Food 
consists for the most part of sugar and starches ; 
Lactopreparata has about the same composition, 
but in it milk-sugar replaces a part of the starch. 
Lactated Food is composed mostly of sugars and 
starches. The Peptogenic Milk Powder of 
Fairchild consists of pancreatin, lactose, and 
alkaline milk salts. The condensed milks 
represent ordinary cow's milk which has been 
evaporated in a vacuum, sterilized, and sweet- 
ened with cane sugar. The unsweetened 
variety can also be obtained. 

The main fact to be kept in mind is that, 
whether such foods approximate more or less 
closely to natural milk, they must and do 



92 THE CARE OF THE CHILD IN HEALTH 

necessarily lose something of their vitality, of 
their nutritive value, in going through the 
process of handling and manufacture. Not 
counting the fact that they are commonly over- 
rich in proteids, and that they vary in the per- 
centage of fat, they are not as wholesome, not 
as invigorating as fresh milk. There are secrets 
in the products of cell activity which we have 
never been able to discover, and among them is 
that profound problem of trying to imitate this 
result of nature's work which is so familiar to 
us, and at the same time so inscrutable in the 
mystery of its making. This is at the basis of 
all our failures at making an artificial food; 
and until the problem is solved Ave should use 
the artificial foods, such as are commonly sold, 
only as a last resort. 

Closely connected with this matter is the 
subject of weaning. The change from the 
breast to the bottle is commonly synonymous 
with domestic disturbances, with unquiet 
nights and days. In many, if not in most 
cases, the natural difficulties of the situation 
are emphasized and exaggerated by a lack of 
conviction and a want of firmness in the par- 
ents. This vacillation is an unfortunate char- 
acteristic of many mothers, and has a strong 



FEEDING 93 

tendency to diminish authority; at the same 
time it has the equally important — some people 
think more important — effect of lessening the 
functional activity of the stomach. 

As was shown on page 82 the feeding should 
take place at regular intervals, and nothing 
should be allowed to interfere with this regu- 
larity; even if the child is asleep, he may with 
profit be wakened when the proper time for 
nursing comes. If this course is pursued he 
will not only contract habits of regularity but 
also will sleep more quietly in the intervals 
and at night. A little firmness of intention 
may be demanded of the mother to inaugurate 
and carry out such a plan, but the reward in the 
way of increased rest and comfort for both 
mother and child will amply repay the effort. 
It will be noticed that the amount of time 
laid out by the schedule for each day does 
not cover four-and-twenty hours; in the re- 
mainder the child is not supposed to receive 
any food at all, on the double principle of 
giving the child's stomach an opportunity to 
rest and at the same time developing a habit 
which permits both mother and child to sleep. 
The period of rest should be confined to the 
middle of the night, and will usually be man- 



94 THE CARE OF THE CHILD IN HEALTH 

aged with ease if the schedule during the day- 
is carefully maintained. When weaning is 
called for, the strict habit thus developed will 
be found to be of marked value. Under ordi- 
nary, normal circumstances the transition 
should take place when the child is one year 
old, and in most cases the process ought to 
be gradual rather than abrupt. One of the 
breast feedings may be replaced by a hand 
feeding ; then, one or two days later, two hand 
feedings may be substituted, and thus one may 
continue until the breast is left untouched. 
During all this time, the integrity of the night 
must be kept untouched. The mother should 
be steadied by the conviction that one ill-timed 
yielding is apt to break up the habit of weeks, 
and that while thereby gaining a few minutes 
of peace she loses many hours of rest. 

Under some circumstances, such as preg- 
nancy, wearing out of the milk supply, or 
acute sickness of the mother, the change may 
have to be made before the beginning of the 
second year. In the last-mentioned contin- 
gency, where the necessity for artificial feed- 
ing is no more than temporary, the milk may 
be prevented from drying up by the consistent 
use of the breast-pump. In the other events 



FEEDING 95 

the best course of action is to recognize the 
necessity of the case, and to make the change 
without too prolonged waiting. On the other 
hand, when the normal nursing period closes in 
the latter half of the summer, the child may be 
kept at the breast, so long as the quality and 
quantity of the milk are sufficient, for a short 
additional period, in order to reduce the possible 
dangers of gastric infection that are greatest 
during the hot weather. This prolongation of 
breast feeding must be made with the full 
knowledge that the quality of the milk is apt 
suddenly to deteriorate, as well as the fact that 
in the beginning of the second year the diet 
normally calls for a food-composition and food- 
bulk which human milk cannot supply. Finally, 
when the child has definitely been taken from 
the breast, the flow of milk may be checked by 
tightly bandaging the breasts, or wearing a 
strong, sleeveless waist which has been snugly 
fitted to the form, and may be tightly pinned. 

During the second year the foundation of the 
food must be good, wholesome, cow's milk. 
After the fourteenth month of age, most healthy 
children are able to digest it in its plain, 
unmodified form; but if any difficulty remains, 
it is almost always on account of the large 



96 THE CARE OF THE CHILD IN HEALTH 

quantity of proteids. In such a case the use of 
the last modification, given on page 81, is to 
be continued. An additional element may now 
be supplied in the way of the various cereals ; 
these are to be made into a thin gruel or jelly, 
strained, and mixed with milk. When the 
little one has demonstrated his ability to digest 
these articles, clear soups, from which the fat 
has been removed, may now and then form a 
part of the diet; next a well-baked apple, stewed 
prunes, and orange juice may by degrees be 
allowed. As the middle of the year approaches, 
he may eat a piece of zwieback, well-toasted, 
stale wheat bread, or toasted biscuit which has 
been dipped in milk. The next step takes him 
to where he may have a poached or soft-boiled 
egg^ scraped rare beef, and stale bread. Natur- 
ally, all these things are not to be given at one 
meal. At this time it is unnecessary to strain 
the cereals as thoroughly as in the earlier 
months. 

As a summary, one may lay out such a menu 
for a healthy child of fifteen months : — 

6.30 a.m., cup of milk with toast or zwieback. 

10.00 A.M., strained oatmeal with milk; 
toasted or crisp biscuit; orange juice; stewed 
or baked apple. 



; 



FEEDING 97 

1.30 p.m., clear soup, chicken, beef, or 
mutton broth; piece of stale or toasted bread. 

5.00 p.m., cup of milk; crisp soda biscuit or 
zwieback. 

7.00 p.m. (just before going to sleep), cup of 
milk. 

The question of feeding this growing child is 
now becoming a very active one. The mother 
must keep to the golden mean between too strict 
and too liberal a diet, for the one is about as 
bad as the other. She must know that there are 
definite needs to be subserved which must be 
closely understood. Good intentions alone are 
not sufficient, nor is the mere fact of a bounti- 
ful supply of food the only thing to be desired. 
She must know that the uses of food are vari- 
ous: to make new tissue, to repair waste of 
tissue, to act as fuel, to supply a reserve force 
for future emergencies, and to act as a guard 
against the exhaustion of tissue or the stored-up 
supplies of other food derivatives. In order to 
do this, certain elements of food must be present 
in sufficient amount, and must be thoroughly 
digested. The great difficulty in infantile life 
lies in the way of this sufficient assimilation. 
Thus the diet should be made up of fats, pro- 
teids, sugars and starches, mineral salts, and 



98 THE CARE OF THE CHILD IN HEALTH 

water. The fats go to make up fatty tissue, 
and at the same time serve as fuel ; the proteids, 
also called nitrogenous foods, are used to make 
muscular and tendinous tissue, and likewise to 
give heat; the sugars and starches go to make 
fatty tissue and to give heat. The mineral 
salts have various chemical uses that require no 
special mention. In infancy, the carbohydrates 
and fats hold a very important place, since they 
serve to develop bodily heat and to produce 
fat. As the child increases in age, the proteids 
must occupy a more important position, since 
they are the basis of muscular growth which 
progressively becomes more necessary. As 
examples of these various kinds we may select 
as representing the proteids, eggs, meats, milk, 
fish, gluten of wheat. As examples of fats we 
may mention butter, fat of meat, sweet oil, 
olive oil, the oils in some cereals. Among the 
carbohydrates are sugars and starches as they 
occur alone and in combination, as, for instance, 
in such vegetables as potatoes, and in cereals. 

These various foods, while different in com- 
position and process of assimilation, have the 
same general function of supplying energy in 
the form of muscular power and heat; and 
although the amount of potential energy con- 



FEEDING 99 

tained in the fats is equal to the combined 
amounts in the proteids and carbohydrates, 
nevertheless the needs of the youthful body and 
its faculty of absorption render the change from 
the small proteid percentage of infancy to the 
larger one of later childhood necessarily slow. 
For in the earlier period the predominant need 
of the organism lies in the combination of heat 
and protection rather than the various forms of 
more active energy; and as the child increases 
in development, the augmented action of body 
and mind calls for additional fuel that is 
designed to subserve these functions. As the 
need for so-called concentrated foods increases, 
the added means for helping in digesting them, 
such as the cutting and grinding action of the 
teeth and the additional caustic nature of the 
gastric secretion, simultaneously come into 
existence. The gastric juice of infancy has 
little corrosive action; it is not capable of dis- 
solving cell envelopes, and its development 
into its later form is very gradual. Morever, 
when that later and more potent form is reached, 
every effort must be made to keep the food as 
pure and as normal as possible. Thus there is 
no need for the pungent and aromatic spices, 
since these things are used as whips to drive a 

U of Q t 



100 THE CARE OF THE CHILD IN HEALTH 

jaded appetite and digestion; there are strong 
objections against preserved, pickled, smoked, 
and dessicated articles, for they have been 
changed from their normal condition on account 
of economical reasons or because the adult 
palate longs for a greater variety than more 
nutritious food gives; likewise, cakes, pies, 
and fresh breads are undesirable, not on account 
of their chemical constitution, but because their 
physical condition permits of the formation in 
the stomach of a large, soggy mass, the exterior 
of which only is affected by the gastric secre- 
tions, while the interior remains unchanged; 
bran bread may often be profitably substituted 
for wheat bread, but the first as well as the second 
should not be used until it is stale ; coffee and 
tea are also to be forbidden, since they contain 
almost no nourishment, but, on the other hand, 
have alkaloids whose action on the nervous sys- 
tem is unnecessary and undesirable for children. 
Again, fried foods of all sorts must not be 
allowed, outside of any consideration of what 
they contain, on the ground that the rapid 
cooking, the high degree of heat used, and the 
tough coating of deteriorated fat produce an 
envelope which is hard to digest, while the 
inner portion is usually affected in unequal 



FEEDING 101 

degrees in its various planes. The object in 
cooking food is to produce chemical changes 
which promote ease of digestion, greater poten- 
tial solubility and assimilation, the develop- 
ment of extractives and aromatic substances in 
the food, and the stopping of fermentative 
action and bacterial life. These results are 
best obtained by boiling, baking, roasting, 
and broiling; and, as a rule, they must be 
thoroughly enough conducted to have the 
resulting changes take place through the 
whole substance of the food. 

In making out the plan for the feeding after 
fifteen months, we may reduce the number of 
meals to four, and at the same time increase 
the number of articles, as in the following : — 

Breakfast, 7 A.M. Cup of hot milk; stale 
bread or toast with butter; well-cooked oatmeal 
with cream or milk, but no sugar. 

Lunch, 11 a.m. Cup of hot milk with bread 
or toast and butter; in place of the bread or 
toast one may give zwieback or crisp biscuit. 

Dinner, 2.30 p.m. Cup of clear meat soup or 
broth from which the fat has been skimmed. A 
very small portion of scraped beef or beefsteak, 
or the bone of a lamb chop on which the child 
may bite and suck. He may have a piece of 



102 THE CARE OF THE CHILD IN HEALTH 

bread, or baked or mashed potatoes and meat 
juice. For a sweet he may eat a small bit of 
curds and whey, custard, junket, rice pudding, 
or bread pudding. Of course all these dishes 
are not supposed to be given at one meal; the 
mother is supposed to make an intelligent choice, 
and vary the menu from time to time. 

Supper, 6.30 p.m. Cup of hot milk with 
bread and butter. 

From the age of one and one-half to three 
years the bill of fare may read as follows : — 

Breakfast, 7 a.m. Clear juice of an orange, 
or the pulp of a baked apple, or apple sauce, or 
stewed prunes; hot milk; well-cooked oatmeal 
or cracked wheat or rice ; stale bread or toast 
with butter. When the child is two years old 
he may have the half of a soft-boiled or poached 
egg; at two and one-half years of age he may 
get a whole egg. 

Lunch, 11 a.m. Hot milk; stale bread and 
butter, or zwieback, or crisp biscuit. 

Dinner, 2 p.m. Plate of clear meat soup or 
broth from which the fat has been skimmed. A 
small piece of roast beef, broiled steak, or lamb 
chop, breast of chicken, or bone of chicken or 
lamb chop. Whatever meat he receives must 
be scraped or cut into very small pieces. 



FEEDING 103 

Bread and butter; baked, mashed potatoes with 
meat juice; boiled rice with cream, rice pud- 
ding, bread pudding, curds and whey, junket, 
custard, stewed prunes with or without rice. 

Supper, 6.30 p.m. Hot milk with bread and 
butter; milk toast. 

After the child is over three years old his diet 
may be gradually enlarged. The meals should 
be reduced to three ; but it will often be neces- 
sary to give a hungry youngster a glass of milk 
at half after ten in the morning, and possibly 
again at three in the afternoon. All foods 
must be plain, without other seasoning than 
salt; there should be no fried foods, "made" 
salads, no pickles or other relishes, no cakes, 
pies, coffee, tea, beer, or wines. The breakfast 
may be about half after seven o'clock, and 
should consist of fruit (orange, baked banana, 
baked apple, or stewed prunes), well-cooked 
oatmeal, cracked wheat, hominy, rice, or farina ; 
boiled, poached, or scrambled eggs; hot milk; 
stale bread or toast with butter. Now and then 
the eggs may be replaced by a piece of broiled 
fish, which is not very fat, or a chop. Robust 
children often appreciate and thrive on corn 
meal, but their delicate brothers and sisters 
sometimes have trouble in digesting it. 



104 THE CARE OF THE CHILD IN HEALTH 

The dinner should be at midday, and should 
always begin with a dish of clear soup, without 
fat, or a meat broth. There may then be some 
sort of broiled, roasted, or baked fish; or the 
soup may be followed by roast beef, chopped 
beef which has been broiled, broiled beefsteak, 
broiled lamb chops, roast lamb, boiled mutton, 
chicken, turkey, or squabs. One or two vege- 
tables, such as baked or mashed potatoes, well- 
boiled spinach, puree of peas, young cauliflower, 
young beans, young carrots, stewed celery, or 
boiled rice, may be allowed with the meat. A 
glass of milk should always accompany the 
meal, which may end with rice pudding, rice 
and stewed prunes, or apple sauce, bread pud- 
ding, farina pudding, sago pudding, junket, 
curds and whey, custard, or one of the fruits 
mentioned in the menu for breakfast When 
the little one comes to be four or five years of 
age he may receive a portion of clear jelly, 
gelatine, preserved pears, peaches, apricots, or 
strawberries. And I have found that a bit of 
good cream cheese with a crisp soda biscuit is 
well liked and well digested by growing chil- 
dren ; incidentally I may say that the nutritive 
value of this cheese is high. 

The supper may be taken at six o'clock, and 



FEEDING 105 

should always be very light and simple. It 
may be made up of milk with bread and butter 
or soda biscuits, milk toast, a dish of rice, 
farina, or hominy with milk, or any of the vari- 
ous milk soups. Baked or stewed apples or 
apple sauce, if they have not formed part of the 
other meals, are very good to end the supper. 

The matter of diet has at times an important 
influence not only upon the child's general 
health but also upon certain physical and men- 
tal functions. In this connection one can men- 
tion no more weighty factor than the condition 
which is commonly called habitual constipation. 
Children are often troubled by it, and as a curi- 
ous fact the disorder seems sometimes to run in 
families. On the other hand, the habits of 
various members of one family may not at all 
resemble each other; and also the condition of 
an individual child may vary from one time to 
another. The whole problem rests upon sev- 
eral possible causal factors; and while diet is 
an important one of them, nevertheless the 
others should have some mention in order to 
give a comprehensive view of their respective 
values. 

The very fact of childhood bears with it a 
certain tendency to constipation. For in the 



106 THE CARE OF THE CHILD IN HEALTH 

early months of life the undeveloped pelvis has 
not room enough for the many coils of intestines 
which therefore are confined to the abdominal 
cavity. Here the yielding walls give no proper 
point of resistance, and therefore the muscular 
fibres are unable to exert themselves to advan- 
tage. An additional hindrance is the mainte- 
nance of any position during defecation other 
than a crouching one. A third reason is the 
congenital or acquired weakness of the intes- 
tinal muscular fibres which naturally are unable 
to do their requisite amount of work. 

Such conditions can be and often are exagger- 
ated by poorly devised meals, irregular times of 
eating, and a too rapid and insufficient chewing 
of the food. The choice of food is always im- 
portant, even in infancy. "If an artificial 
food is the diet, it must be made to simulate in 
its physical and chemical composition mother's 
milk. If breast milk is the food, and if on 
analysis it proves to be deficient in fat, then 
the requisite amount of cream may be given 
after each feeding. If the milk be too rich in 
proteids, the daily life, diet, and exercise of 
the mother or nurse must be so regulated 
that the excretion becomes normal. If the 
milk for any reason remains abnormal, it is 



FEEDING 107 

much better in the long run to wean the child 
without delay." 1 

Older children should have such foods as are 
not too fine. Bread which is made from the 
whole wheat, graham bread, corn bread, and 
rye bread are better than that made from the 
thoroughly bolted wheat flour. Any fresh ten- 
der meat among those mentioned earlier in this 
chapter as desirable may be allowed. The 
desserts should usually be made of fresh or 
stewed fruits. The milk which the child 
drinks should be unboiled, and must contain a 
large percentage of cream. Both cream and 
butter are of considerable use in such a diet. 
Children over four years may have moderate 
amounts of good cream cheese. The diet 
should not include dried or canned foods, but 
in their place fresh foods must be used. In 
addition to such a plan, the child may be encour- 
aged to drink liberal quantities of water. These 
measures reinforced by exercise, massage, pos- 
tural treatment, and occasional medical over- 
sight are capable of correcting almost any case 
of habitual constipation. 

When a child is directed to drink liberal 

1 Oppenheim : "Medical Diseases of Childhood,' ' The 
Maemillan Company. 



108 THE CARE OF THE CHILD IN HEALTH 

amounts of water, the reservation must be kept 
in mind that the water should be pure. Under 
ordinary circumstances, especially in large 
cities, this quality is not easily obtained. It 
is really rare to find a water supply that can 
unreservedly be praised, and too often it ought 
to be condemned. As a result of this state of 
affairs, parents should see to it that the water 
which their little ones drink has been made 
acceptable and harmless. They can insure 
both palatability and safety by a proper method 
of filtration, which is not very hard to obtain. 
The filter must be attached to the supply pipe 
of the house, and not to a faucet. It must be 
so devised that no pressure is exerted by the 
common water supply upon the filtering medium, 
for the process must be one of slow percolation. 
Moreover, the apparatus must be of such a kind 
that the filtering membrane can easily be re- 
moved, cleansed, or renewed. 

There is no doubt that by such a device a 
certain amount of the acute specific fevers as 
well as a respectable proportion of diarrhoeal 
troubles may be avoided or diminished. Its use 
is the logical extension of our ideas of asepsis 
and the application of them to important 
although ordinary facts of life. But such facts 



FEEDING 109 

are the very ones that ought to receive our most 
careful attention, for they serve as the founda- 
tion of the more attractive features of our 
careers. 

From the earliest possible time the habit of 
eating slowly and chewing the food very 
thoroughly must be insisted upon. If this is 
begun at an early enough age, it is easily 
learned and will prove to be a valuable acqui- 
sition for later years. If the child eats with 
an attendant or with the rest of the family, he 
should be allowed to talk to a reasonable 
extent; speech should be regulated, not for- 
bidden. For with children, as well as adults, 
the act of speaking causes useful breaks in the 
steady course of masticating and swallowing 
food; it allows the gastric contents to be well 
mixed with the secretions of the stomach, and 
at the same time it provides an atmosphere of 
reasonable enjoyment that a child may claim 
as well as his elders. The rule that children 
should be seen and not heard is capable of too 
strict an interpretation that lends itself very 
readily to petty domestic tyranny. So long as 
there is a reasonable and healthy discipline in 
the household, every child should be allowed to 
talk, to take part in the family life, to feel 



110 THE CARE OF THE CHILD IN HEALTH 

that he is an integral part of the home circle, 
and to realize that his words — even if they be 
not heavy with wisdom — will receive the con- 
sideration and attention which abiding love 
and a mild tolerance dictate. The ordinary 
child, whose environment provides suitable 
examples of self-restraint and good manners, 
learns in a surprisingly short time how to con- 
trol himself within sufficient bounds to be 
reckoned as a human being, and not as a more 
or less untamed animal. 



CHAPTER V 

BATHING 

The necessity of cleanliness is not the only 
reason for systematic bathing ; and although 
cleanliness is a sufficient reason, it is comforting 
to know that at the same time and by the same 
means a beneficial effect may in other respects be 
exerted upon the body. This fact holds good for 
persons of all ages; and in some ways the young 
child will receive a greater aid from the wise 
use of water than his parents. In him the 
process of tissue-change is especially active, 
secretion and excretion are naturally brisk, and 
the skin, which has an important part to play 
in all people, is in him particularly important. 
One must keep in mind certain plain facts about 
the skin, for it is more than a mere exterior 
finish to the body. In addition it is a most 
valuable organ of sensation, upon whose exact 
working much of our general physical safety 
depends, while at the same time it serves as the 
active agent of some of our most massive and 

ill 



112 THE CARE OF THE CHILD IN HEALTH 

satisfactory pleasures. Besides this, it is an in- 
dispensable excretory organ, without which the 
life of the body could not be continued. By 
this means the organism relieves itself of a large 
amount of water, of carbonic acid, of urea, and 
doubtless of other matters; it seems quite certain 
that even bacteria may be thus excreted. In 
the process of draining off waste products, the 
skin bears a close relation to the kidneys : there 
is a marked similarity between the chemical 
composition of the sweat and the urine, while 
more than a few observers have noticed the 
resemblance between the anatomical structure 
of the skin and one of the essential portions 
(the glomerulus) of the kidney. Yet another 
function is that of a heat regulator, by which 
heat is freely radiated when the temperature is 
high, and kept within the body when the tem- 
perature is low. For this reason burns cover- 
ing three-fourths of the surface are fatal; and 
physicians are thoroughly familiar with the 
seemingly strange fact that extensive burns so 
interfere with the distribution of heat that 
serious congestions of the internal organs occur, 
and may be followed by the formation of ulcers. 
These facts are in themselves sufficient to 
show the necessity of keeping the skin active 



BATHING 113 

and clear ; but they are not all that ought to be 
mentioned. If it is true that the outer surface 
of the body acts as a sense organ, as an excre- 
tory organ and as a heat regulator, it is equally 
true that it exerts a considerable effect upon the 
circulation of the blood and is therefore a sort 
of " skin-heart." It is a noteworthy fact that 
almost a third of the blood is contained in the 
superficial vessels, and this large amount of 
fluid is directly influenced by the dilatations 
and contractions of the capillaries. The arte- 
ries are by no means mere passive conducting 
tubes; on the contrary they have a keenly sen- 
sitive nerve supply which causes them to con- 
tract when only a little blood should be in them, 
and again to expand when they ought to hold 
much blood. By the activity of the layers of 
muscle fibres they can and do help to propel the 
blood through the capillary vessels, for the large 
amount of fluid at so great a distance from the 
central pumping station which we call the heart 
might otherwise be moved Avith difficulty. It 
is not an exaggeration of the facts in the case 
to say that the functional value of these vessels 
is fully as great as that of the vessels of the 
lungs, or the stomach, or the kidneys. Each 
set has its work to do, and the efficiency of the 



114 THE CARE OF THE CHILD IN HEALTH 

body as a whole depends on the satisfactory 
manner in which each discharges its duties. 

The simplest and most natural means to in- 
sure the health and activity of the skin is by the 
common-sense use of pure soap and water accord- 
ing to certain well-known rules. No help is 
needed from the many powders, creams, oils, and 
lotions which are sold in such great quantities. 
In most cases one does not know the composition 
of these articles. They may contain inert or 
harmful ingredients, while they frequently 
enough serve to clog up the skin, and in a va- 
riable degree diminish its efficiency. For very 
young babies a simple dusting powder may be 
used in the folds produced by the large amount 
of fat, since by this means the inevitable friction 
and the resulting local irritation are obviated or 
diminished. But even in this case, the mother 
should clearly understand that the powder has 
no reason for existence excepting to prevent 
local chafing; it is not meant to "strengthen 
the skin," to absorb urine, or to exert any in- 
fluence upon the general condition of the child. 
If irritation of the skin occurs, especially about 
the buttocks, the cause usually lies in some in- 
ternal disorder and cannot be cured by a powder. 

All children should be bathed daily, and the 



BATHING 115 

habit of bathing that is usually begun almost 
directly after birth should be continued through 
the whole of the little one's life. For the first 
six months the temperature of the water may 
be about 100° F. The bath may be given about 
nine or half after nine o'clock in the morning, 
and should come immediately before rather than 
immediately after a nursing. The general 
statement holds good that the longer the inter- 
val between a bath and the preceding meal, the 
smaller is the possibility of unfavorably influ- 
encing the digestion of food; for it is well 
known that the stomach when it receives food 
draws a large quantity of blood from the surface 
into its vessels, and the bath, by dilating these 
superficial arterioles, defeats the very condition 
upon which the integrity of digestion depends. 
Therefore, in infancy the bath may be given an 
hour and a half after the nursing, and in later 
life about two hours and a half after the last 
meal. Before the baby is put into the water 
one must be sure that there are no draughts in 
the room, that the windows are carefully closed, 
unless the weather is very warm, and for added 
safety that the screen protects the locality of 
the bath-tub from the direction of any possible 
exposure. In cool or cold weather the tub 



116 THE CAKE OE THE CHILD IN HEALTH 

should be placed in front of the fire, so that the 
wet skin may receive as little chilling as pos- 
sible. The person who bathes the child should 
wear a large apron, made preferably of some 
soft, thick material, one of the best of which is 
Turkish toweling. This should not interfere 
with the use of a large Turkish towel with 
which to dry the baby; this towel must be 
thoroughly clean and warm before being used, 
and should not be employed for more than two 
successive days without being washed. There 
should be enough water in the tub to cover 
the baby's chest, and as the little one reclines 
in the tub the attendant's left hand should sup- 
port his back, her forearm should hold up his 
head, while her right hand does the washing. 
As soon as the child is immersed, his head may 
be dampened with water that is slightly cooler 
than the water which surrounds his body. A 
pure, unscented white soap should be used 
rather than the expensive fancy toilet soaps, 
which are in many ways undesirable. The 
washing may be done with the bare hand or 
with a fine sponge, and should start at the face 
and proceed to the feet. The eyelids should 
be carefully cleansed and all secretions removed 
from the corners and the eyelashes ; the ears may 



BATHING 117 

be thoroughly washed, but without sticking any- 
pointed object into their canal; the mouth may 
be washed with a fine piece of linen and a solu- 
tion of boric acid; especial attention must be 
given to all folds, creases, the buttocks, and 
wherever two skin surfaces touch each other. 
In little girls the two outer lips of the vulva 
should be separated and cleansed, and in little 
boys the foreskin of the penis should be drawn 
back twice or thrice in a week, and the parts 
thoroughly cleansed of any trace of urine or 
smegma. As soon as the washing is completed, 
the child should be rinsed off with fresh water 
that is slightly cooler than that of the bath. 
He may then be rolled up in the towel and 
rubbed with the hand. As soon as he is well 
dried, he is to be stripped once more and 
thoroughly rubbed with the bare hand; if 
there is any necessity for using alcohol in 
these frictions, the family physician will give 
the order. The buttocks and opposing surfaces 
may then be powdered, the clothing adjusted 
as quickly as is convenient, and the child 
snugly placed in his crib. He is now ready 
for his meal, after which, if he is in good 
health, he will sleep so sweetly, look so dainty 
and rosy, and awake so refreshed, that the 



118 THE CARE OF THE CHILD IN HEALTH 

operation of bathing must necessarily be re- 
garded as a joy. 

During the rest of the day, some additional, 
but partial, washings are needed. After each 
feeding the mouth may be lightly cleansed with 
a fine cloth and a solution of boric acid or borax ; 
and with the removal of each diaper the but- 
tocks should be carefully washed, rinsed, dried, 
and powdered. Again at evening, before the 
child is put to sleep for the night the face, 
buttocks, and creases of the body may be lightly 
sponged and thoroughly dried. These are the 
general rules that govern an infant's care for 
the greater part of the first year; but in sum- 
mer a little more attention is needed. Nothing 
afflicts and depresses a baby more surely than 
intense heat and humidity, in some cases to 
such an extent as to be a clearly understood 
cause of weakness, loss of strength and appe- 
tite, and even of active disease. To guard 
against these contingencies we may use two, 
three, or even four sponge baths in the course 
of a hot day; and in a close and heavy night, 
when even strong adults are unable to sleep, 
we can soothe and put the tormented baby into 
a quiet slumber by a liberal use of lukewarm 
water. The common fear that more than one 



BATHING 119 

bath per day is weakening should be regarded 
as idle and superstitious; in most cases where 
an error is made it is more apt to be on the side 
of too little rather than too much washing. 

From the second year the temperature of the 
daily bath may be somewhat reduced ; the child 
will then be able to enjoy water of 85° or 80° F. 
instead of 100° or 95°. The bath must con- 
tinue to be given in the morning, but instead 
of waiting until half after nine o'clock it may, 
if the mother wishes, be given on arising. The 
main difference is one of heat, for if the weather 
is at all cool most houses are too chilly to bathe 
an infant early in the morning When the bath 
is completed, the child's skin maybe rubbed more 
vigorously than one may do with the younger 
infants. For this purpose the mother may use 
the bare hand or a Turkish towel that is not too 
harsh. The friction should be long enough and 
brisk enough to cause the skin to react in a 
thorough manner; the surface should be in a 
fine blush, should feel warm and full of life, 
and the little one ought to be lively and happy. 
Since at this time of life the bladder and rec- 
tum should be under fairly good if not perfect 
control, there will be less necessity for repeated 
washings during the day. In the evening, 



120 THE CARE OF THE CHILD IN HEALTH 

however, before the baby is put to bed, he should 
receive the light sponge bath in order that all 
the creases and folds of the skin may be 
thoroughly sweet and clean. Likewise, at this 
stage of development, when in most cases the 
teeth are steadily making their appearance, the 
mother should begin the use of the tooth-brush. 
This brush must, of course, be very soft, and 
in using it one must have a light touch; and 
so long as these requirements are observed 
there is a full justification for thus cleansing 
the teeth. In most cases the tooth-brush is 
not used until a considerably later period. But 
this is not necessary or rational; a single tooth 
has the same right to the benefit of cleanliness 
that ten have, and the same arguments are 
applicable to the one as to the many. The 
mother must, however, remember that the 
mucous membrane of the gums is exceedingly 
delicate, and cannot well endure violent rub- 
bing. A bland powder, such as precipitated 
chalk, may be used, and may be applied morning 
and night. 

At three and a half years of age the tempera- 
ture of the bath may be reduced to 70° F., and 
then by easy stages to 65° or 60°. The fric- 
tion following it should continue to be satis- 



BATHING 121 

factory in both duration and force, although the 
length of time spent in the water need not be 
at all long. In fact, as soon as we begin to 
make the water cool, the duration of exposure 
should be correspondingly short. There may, 
therefore, be a need of one or two hot baths per 
week, which are most conveniently given in the 
evening. It is undesirable to give them after 
the evening meal, because the child would 
have to remain awake too late in order to allow 
a sufficient interval to elapse between the meal 
and the bath. The best plan is to bathe him 
directly before supper, then to put him to bed, 
where he may be fed with safety and comfort. 
He will immediately fall into the deep and 
unruffled sleep of childhood, which will be 
made all the sweeter on account of his clear and 
active skin and his satisfied appetite. 

It is a good plan to begin with children of 
about four or four and a half years of age the 
practice of cool effusions or douche baths. The 
beginning should always be made in the late 
spring or early summer, when the warm air 
makes the impact of the water both bearable 
and welcome ; but when once begun it should 
be continued through the whole year, being 
intermitted only in the event of sickness. To 



122 THE CARE OF THE CHILD IN HEALTH 

prepare this bath one should begin by allowing 
about ten inches of warm water to run into the 
tub, the object of which is to keep the child's 
feet thoroughly warm. Then water directly 
from the faucet may rapidly be thrown over 
him. This may be done in two or three differ- 
ent ways. The water may be allowed to run 
over him from an overhead douche, it may be 
thrown over him from two or three full pitchers, 
or it may be sprinkled through a rubber tube, to 
the end of which a douche nozzle is attached. 
A good variation of the last method consists in 
using a large sprinkling-pot. The use of the 
pitchers has much to recommend it: the tem- 
perature of the water is easily regulated, the 
force of the impact is likewise controlled, and 
the time consumed by it is exceedingly small. 
The douching need consume no more than a 
minute or two, but the final friction may cover 
from five to ten minutes. If, after being 
dressed, the child is warm, rosy, and comfort- 
able, the bath is doing good; if he looks blue, 
cold, depressed, and is shivering, he is not being 
helped, but rather is suffering from too long an 
exposure or too low a degree of temperature. 
It is often surprising to see how quickly a 
child of no more than six years will become 



BATHING 123 

used to this treatment, and how readily he 
will welcome the use of cold water even when 
the weather is cold. 

Yet another method that has given satisfac- 
tion to many mothers is the familiar tub-bath, 
which is commonly used in England. The 
water is drawn into the tub at least two hours 
or even in the evening before it is to be used. 
During this period it assumes the temperature 
of the room, and therefore gives very little 
shock at all, excepting in a very cold room. 
Under the latter circumstances the duration of 
the bath is momentary, and immediate and brisk 
friction is needed to insure a good reaction. If 
this tubbing is selected to be the daily habit, 
there will be a necessity for one or two hot 
baths per week at evening to insure the thorough 
cleanliness of the skin. Into either the hot or 
the cold bath one may dissolve sea salt, accord- 
ing to one's fancy or belief in its virtues. This 
belief is widespread, and is held by many physi- 
cians as well as laymen. Its physiological basis 
is not easy to recognize, since it certainly does 
not inhere in any absorption of the salt through 
the skin. Such absorption is exceedingly 
difficult and can be accomplished only under 
exceptionally favorable circumstances. If this 



124 THE CARE OF THE CHILD IN HEALTH 

were not true, we should receive the character- 
istic effects of all the various substances, both 
harmful and harmless, by which we are con- 
stantly surrounded. The cook, in the course 
of preparing a single dinner, comes into contact 
with various articles which, if thej were directly 
absorbed through the skin, would have a marked 
effect upon her physical condition. Thus, she 
majr handle acetic acid in vinegar and hydro- 
chloric or sulphuric acid in cleaning fluids; 
the alkaline salts of soda or the neutral common 
table salt; bland and soothing starches or sharp 
and irritating condiments and spices; clean, 
sterile water, and bacteria-laden fruits, meats, 
and cheese. Nevertheless, as every one knows, 
she is not at all influenced, simply because of 
the impermeable barrier of her skin, that valu- 
able excretory, but not assimilative organ. In 
the same way the painter, the dyer, the chem- 
ist, and a host of other workers who are bound 
to come in contact with drugs and chemicals, 
are efficiently protected. 

Thus, one can easily see, without going into 
the technicalities of physiology, how the bene- 
ficial effect of artificial salt baths is not founded 
upon a question of absorption. Most of all it 
is rational to suppose that if such absorption is 



BATHING 125 

necessary, it would be an easy matter to admin- 
ister these salts internally. Some observers 
have thought that the salty solution, although 
not absorbed, acted as a local stimulant and 
caused the skin to act more briskly than it 
otherwise would. This theory is at best of 
doubtful value. In all likelihood the chief 
value of the procedure lies in the greater care, 
thoroughness, and regularity of the bath and all 
its accessories which the directions of the family 
physician or the special condition of the child 
necessitate. Doubtless, if the same care were ex- 
ercised, even without the addition of salt to the 
water, equally good results could be obtained. 

This question is quite different from that of 
bathing in the salt water of the ocean ; here the 
exercise in the open air, the inevitable struggle 
with the moving water, the playing in the sand, ' 
the sense of freedom, the exhilaration, and the 
buoyancy of mind as well as body that sea bath- 
ing gives, have the possibility of benefiting the 
child in quite a different way from what the 
ordinary bath at home can do. The difference 
is analogous to that between exercising with 
chest weights at home or playing a game of 
base-ball or foot-ball in a field ; the first may give 
strength of muscle, and thus lead to greater 



126 THE CARE OF THE CHILD IN HEALTH 

functional activity of the whole body ; but the 
second gives both health and strength in a more 
direct and inevitable manner. Bathing at home 
is not only desirable, but also necessary; bath- 
ing in the sea is, in addition, a tonic for mind 
and body. There is no reason why a child 
should not partake of its benefits in the same 
way that an adult does. The one precaution 
which the mother should observe is the possi- 
bility of a rapid chilling and a consequent gen- 
eral depression. A child of five years of age 
may safely be taken into the water, but as soon 
as his lips and finger-tips begin to turn blue 
and his teeth begin to chatter, he must be 
removed, rubbed briskly, and well dried and 
warmed. Besides the mere act of bathing he 
should be allowed to play about in the sand, 
before he takes his dip, as long as he wishes. 
Let him dig, build houses, make mud pies, and 
get himself as dirty as his heart desires; let 
him have unrestrained liberty, encourage him 
to use whatever investigating and constructive 
ability he may possess in the mobile medium of 
the sand; let him be warmed in spirit as well 
as in body, and he will find a different sort of 
health and strength from what he obtains at 
home, and at the same time will lay up 



BATHING 127 

memories of enjoyment. A child from his 
earliest age should be made familiar with 
water, should be taught to regard the bath as 
a treat and a pleasure, should be accustomed to 
resort to it just as readily when exhausted as 
when dirty. Doubtless, it would not be far 
from the rigid truth to say that the civili- 
zation of a people is measured by the amount 
of water which they use for their personal 
needs. And it is comforting to know that one 
can scarcety use too much water. This rule 
should be impressed upon every youthful mind 
until its workings may become manifest in the 
unconscious impulses that go to make what we 
call second nature. 



CHAPTER VI 



SLEEP 



The main business of a young child, outside 
of eating, is sleeping; one might state the 
matter somewhat differently and say that the 
principal necessities of a child are absorbing 
nourishment and obtaining rest. In health the 
faculty of the latter is, to a certain extent, self- 
regulating: a normal child may easily overeat; 
he practically never oversleeps. Of the two 
functions in question, the second is sometimes 
regarded as the more important; for he can go 
without food for a longer time and with less 
exhaustion than he can spare sleep. And 
reasoning in this wa}^, if one wishes to compare 
the respective values of eating and sleeping, 
one would have to decide that sleeping is the 
more vital. This principle of sleep, or rest, 
may be found in the normal action of every 
part of the body. Thus, for example, the heart, 
which seems to be working ceaselessly, has a 
well-known period of rest, amounting to about 

128 



SLEEP 129 

one-half second between each relaxation and 
contraction of its muscular tissue. One would 
be quite exact in saying that during this period 
the heart sleeps. The muscles of breathing have 
a similar period of rest, that amounts to about 
two seconds, during which they also may rightly 
be said to sleep. If one cares to push one's 
observations yet further, one will clearly recog- 
nize that the same rule may be noticed in 
regard to all muscular action, and, indeed, all 
the various functions of the body. There must 
be a definite period of rest for each part of the 
organism, which will be all the more profitable 
if the laws concerning it are clearly understood 
and logically carried out. 

One of the first things to understand is that 
any part of the body at rest demands less stimu- 
lation and a smaller blood supply than when it 
is working. As an example, we all know that 
if we exercise an arm in an active way, it imme- 
diately feels wider awake than it did before, it 
obtains a sensation of warmth, it is even some- 
what larger in circumference than it otherwise 
would be. The reasons for these changes are 
the active wear and tear, the rapid tissue- 
change, and the increased amount of blood in 
the part; and when the period of exercise has 



130 THE CARE OF THE CHILD IN HEALTH 

passed and the member is at rest, fatigue takes 
the place of activity, the added warmth and 
increased size fade away as the amount of blood 
is gradually equalized throughout the body. A 
similar set of facts is true for the stomach; 
when it obtains food, the pale hue of its mucous 
membrane becomes both deeper and brighter, 
the tissue may be seen to be heavier and more 
turgid than it formerly was, and a keen activity 
takes the place of somnolence. But as soon as 
the work is done, the conditions of activity have 
no longer any reason for existence and the organ 
reverts to a state of sleep. The brain has a 
strictly analogous group of circumstances : dur- 
ing the waking hours, and sometimes when 
sleep is imperfect, it is working with more or 
less industry, it draws to itself a large amount 
of blood to carry on its functions, it actually 
increases in size, and assumes a brighter hue 
than it had during rest. This continues until 
fatigue sets in, or until the person falls asleep. 
Then a temporary anaemia results, the color of 
the brain becomes lighter, its increase in size 
passes away, and its chemical changes fall to 
the minimum. 

These facts give us a clear idea of the con- 
ditions which we should provide for the sleep- 



SLEEP 131 

ing child: there should have been a reasonable 
amount of active exercise, sufficient to fatigue, 
but not exhaust him; during the period 
immediately before retiring he should have 
undergone no great excitement, for unusual 
commotion would naturally tend to produce 
cerebral congestion rather than ansemia; his 
sleeping room should be dark and comfortably 
cool, since such an environment leads to mental 
calm and opposes active disturbance; the air 
should be clean and pure, in order to allow a 
satisfactory oxygenation of the blood; the body 
and clothes must be fresh and clean, for these 
factors help the processes of excretion, and, 
negatively, are fully as important as proper 
breathing ; the sleeping time should come within 
a reasonably short period after the last meal, 
for where the stomach contains and is actively 
digesting food it draws into its blood-vessels a 
comparatively large amount of blood, thus creat- 
ing some degree of anemia of the brain. The 
time-honored aphorism which advises exercise 
after a meal has less truth than is commonly 
supposed; on the contrary, the best thing that 
one can do is to rest. And the heavier the 
meal, the greater is the necessity for resting. 
Even if one knew nothing about the physiology 



132 THE CARE OF THE CHILD IN HEALTH 

of the question, one's experience in feeling 
drowsy after having eaten well, and the com- 
mon knowledge that animals regularly wish to 
sleep after eating any substantial amount, would 
inevitably direct one's thoughts in the right 
direction. The same course of reasoning that 
forbids bathing directly after eating counsels 
sleeping after eating. 

The younger the child, the more easily does 
his brain become fatigued, and the greater is 
his need for rest. This fact every one knows 
from practical experience ; and thus we know, 
both theoretically and practically, that during 
the first three months of life he should spend 
nine-tenths of the whole day in sleep; from 
three to six months he will be awake for six or 
seven hours ; in the next quarter year he will 
usually sleep about one hour less, and when he 
is in the second year, twelve hours at night and 
about two hours in the day will satisfy his 
needs. The practice of taking a nap after the 
noon hour is a thoroughly good one, and should 
be continued as long as the child's activities 
and duties permit. This will generally be not 
longer than his seventh year, although this age 
creates no natural limit to the practice. On 
the contrary, the unceasing activity of early 



SLEEP 133 

childhood makes some such rest highly desir- 
able, and the result will necessarily be a 
stronger body, a better disposition, and firmer 
nerves than otherwise. The fact of taking this 
nap should not in any way interfere with the 
rule of early retiring : children of one and a half 
or two years should regularly go to bed at half 
after six, or, at the latest, at seven o'clock; 
those of three, four, and five years may remain 
up an additional half-hour. Thereafter the 
increase over this time must be made very 
slowly, so that at thirteen or fourteen years of 
age the hour of retiring is no later than half 
after eight o'clock. There is absolutely no 
justification for the long hours which growing 
children are so commonly allowed to have, 
most of all in large cities. Such children are 
very apt to show some manifestation of pre- 
cocity which is commonly destined to assume 
a vicious or, at best, an unfortunate aspect. 

In regard to the sleeping garments, the same 
general rules which were suggested in describ- 
ing an infant's outfit hold good. In summer 
they may be made of muslin, cambric, and nain- 
sook; in winter such material may be replaced 
by some of the various forms of pure wool, of 
mixtures of wool and silk, or of a fine brand of 



134 THE CARE OF THE CHILD IN HEALTH 

Canton flannel. They must be large enough to 
do away with constricting effects, they are pre- 
ferably closed with tapes, and should never be 
fastened with pins. The skirts may extend to 
the feet, or one or two inches below them; but 
the use of the really long skirts is to be depre- 
cated. If the child is weak or has so poor a 
circulation that his feet are often cold, one can 
contribute to his comfort and well-being by 
putting a hot water-bottle at the soles of his 
feet. Such children are the ones that cause 
concern on account of their liability to throw 
off the covers and thus expose themselves. 
This can easily be prevented by sewing tapes to 
the corners of the blankets, which are thus to 
be fastened to the posts or the railings of the 
bed. For children of two and a half years or 
more the nightgown may give way to the union 
suit, the legs of which are lengthened into the 
form of stockings. These suits may be made 
of wool or Canton flannel, and there should be 
a large enough supply to render unnecessary 
too frequent washings. These older children, 
as their younger brothers, may have the lightest 
fabrics for their summer garments. A child 
thus clothed, lying on a hair mattress, very 
lightly covered with a sheet in hot weather, 



SLEEP 135 

and with woollen blankets in the winter, in a 
cool, dark, quiet, and well-ventilated room, 
should sleep a sweet and refreshing sleep. 

There are certain objectionable practices in 
common use that are important enough to merit 
a special mention. One of these is the habit 
of rocking and singing a child to sleep. This 
form of infantile tyranny is quite without 
reason, it destroys domestic discipline, makes 
the infant captious and exacting, and is undoubt- 
edly burdensome to the mother. A healthy 
baby of good habits will go to sleep if he is 
merely placed in his crib at the proper time and 
with the proper environment. If he does not 
fall asleep readily, the cause lies either in bad 
training or in bad health. The first is to be 
remedied by the mother, and should be as cer- 
tainly done as she would live up to any other 
important principle of conduct; the second, if 
it certainly exists, should be adequately treated 
by a competent medical man. At all events, 
the child, the mother, and the household at 
large must understand the circumstances of the 
case and the necessity of self-restraint and firm- 
ness. Especially must the mother be on her 
guard against this abuse after an acute sick- 
ness, for then the ordinary rules of feeding may 



136 THE CARE OF THE CHILD IIST HEALTH 

have necessarily been put aside, the child may 
be irritable and tormented by the so-called 
" false hunger " of invalids, and within a short 
time the bad habit is formed. But as soon as 
convalescence sets in, the child ought to be 
subjected once more to his salutary discipline, 
to which he will submit if he sees sufficient firm- 
ness of purpose in his parents and attendants. 

Another related abuse is the employment of 
an empty rubber nipple or a "sugar teat" to 
keep the baby quiet by allowing him to suck on 
it; some women go so far as to allow sucking 
on one of their fingers, on a coin which is held 
by a string, or a piece of ivory, or any other 
convenient material. Thus to take advantage 
of the infant's sucking reflex is not nearly so 
clever as it may appear at first glance. In all 
but the very youngest it produces an excessive 
quantity of saliva; it is a common cause of 
mucous erosions; it causes the bad habit of 
depending upon continuous sucking for putting 
the child asleep, or amusing him, or even for 
keeping him quiet. One of its worst faults is 
the fact that its lack of surgical cleanliness 
must and often does result in sickness, for by 
this means various forms of germ-life are put 
into the baby's mouth. The " comforter " may 



SLEEP 137 

have dropped in the bed, on a chair, or on the 
floor, and as soon as the child cries it is imme- 
diately put back in his mouth without even the 
preliminary of washing. Finally, it leads to 
the habit of thumb sucking and the attendant 
evils. 

Some families, especially those whose first 
habits of housekeeping have been acquired in 
Europe, use feather-beds as the main covering 
for their children in the winter nights. It is 
unnecessary to mention more than the uneven 
distribution of the feathers, and therefore of the 
heat, and the impossibility of thoroughly airing 
the feathers to show how unadvisable this cus- 
tom is. Better protection can more easily be 
obtained by light but comfortable blankets, the 
warmth of which is spread evenly over the 
whole bed; such covering can easily be increased 
or decreased, it is easily manipulated, and easily 
kept clean. A further objection should be made 
to the habit of sleeping in one position during 
the whole night; from the first day of life the 
child should be placed on the side, and from 
time to time should be changed from one side 
to the other. It is unnecessary and undesirable 
to produce a one-sided pressure upon the head, 
most of all in infancy, when the bones are so 



138 THE CARE OF THE CHILD IN HEALTH 

soft as to be moulded by a continued pressure 
upon one spot. Likewise, the custom of main- 
taining a light in the bedroom during the whole 
night should be abolished ; for it tends to make 
sleep less sound, and develops a fear of darkness. 
Of the two, the second danger is to be the more 
avoided, since by such factors the whole char- 
acter may be injuriously affected. Finally, the 
mother should so arrange the blankets that the 
child's hands are always outside of them; if 
this custom is cultivated in early childhood, it 
may in later years save the child from falling 
into certain bad habits, which will be men- 
tioned in a later chapter. 

If these suggestions are carried out, the 
children who do not rest quietly will be few. 
Nevertheless, there will always be some com- 
plaints on this score, so that it is desirable to 
say a few words concerning it. In young 
children the causes which lead to insomnia are 
sickness and pain, over-excitement and nervous- 
ness, and, finally, bad feeding. The factors of 
sickness and pain should be so easily recognized 
and understood that no mention need be made 
of them. Great excitement and nervousness 
are legitimate causes which, although common 
enough, have no good reason for existence ; for 



SLEEP 139 

the life of a baby should be as monotonous as 
possible, it should be protected from all com- 
motion, and should in all ways be well shielded 
from surprises. Such a child ought to have no 
part in domestic celebrations, rejoicings, or occa- 
sions of emotional disturbance. Since he is too 
young to know the import of events, he need 
not participate in them. A disregard for these 
suggestions can easily bring about so perturbed 
a state of mind and body that the necessary 
conditions of sleep are not easily obtained. But 
the most common cause of disturbed sleep is 
some form of gastric or intestinal derangement 
which, in the majority of cases, follows improper 
feeding. The manner of occurrence is simple 
enough for any one to understand : certain arti- 
cles of food are taken into the stomach, but, on 
account of their indigestibility, or weakness 
and fatigue of the stomach, they are not fully 
changed nor properly prepared for absorption. 
As the result, products of partial digestion are 
formed, the gastric contents decompose and 
give rise to gases and matters of fermentation 
and putrefaction. These are absorbed in vari- 
ous degrees, and act as the means of a low form 
of poisoning. At the same time, the working 
of the body is sufficiently impeded to prevent 



140 THE CARE OF THE CHILD IN HEALTH 

the draining off of the waste matter. The situa- 
tion, finally, amounts to a lack of nourishment 
even if the food be plentiful, combined with 
the formation and retention in the system of 
toxic agents. Some of the symptoms of this 
condition are greater or less pain, a deficient or 
capricious appetite, restlessness and nervous 
irritability, congestion of one or more parts, 
mental depression and uneasiness. In conse- 
quence of these abnormalities, the child is 
plainly unable to be quiet or to sleep; every 
member of his body may be tingling with its 
nervous tension, his mind instead of being calm 
and peaceful is harried by frightful images, 
unnatural and grotesque impressions, and a 
lowering of its ordinary tone, which in an 
adult would be translated as black despair. 
He, of course, is unable to sleep; or, if he 
should happen to doze, his sleep is no more 
than a fitful, unrefreshing, unsatisfactory lack 
of consciousness from which he is apt suddenly 
to start in terror. 

Such a condition is one of the commonest 
causes of nightmare. The pitiable spectacle of 
a child's awaking from a seemingly sound sleep 
with cries of abject fear is enough to touch a 
callous heart. There is no doubt that the little 



SLEEP 141 

one suffers as acutely as if the fancied horrors 
were real; and that in itself would be enough 
to call for a wise regulation of his body and 
mind, which would have the end in view of 
obliterating his suffering. But as a matter of 
fact, very much more than suffering is thus 
entailed. These pathological effects produce 
decidedly harmful impressions on his mind, 
they rob him of his mental freedom and bravery, 
they may render him self-conscious, effeminate, 
deceitful, and, possibly, degenerate. If he 
suffers from night-terrors of a different origin, 
such as central nervous disturbances, or eye- 
strain, the results may be similar in kind, 
although frequently less in degree. But under 
all circumstances and whatever their origin may 
be, they should never be lightly passed over. 
They are worthy of the most serious attention. 
But even if markedly pathological effects are 
not manifested, there may be many conditions 
where sleep is not perfect or where all of the 
brain is not at rest. The ordinary phenomenon 
of falling asleep means no more than that the 
major part of the brain is at rest. One or more 
areas may be more or less awake, and partially 
prepared to show their characteristic activity. 
The various functions of the body are controlled 



142 THE CAKE OF THE CHILD IK HEALTH 

by definite centres in the nervous system of 
brain and spinal cord, in the same way that the 
various mental concepts have their respective 
localities in the brain. Any one of these dif- 
ferent areas, or a group of them, may be partly 
awake, may become stimulated even though the 
child is asleep. The result of such activity 
expresses itself in what we call dreams. And 
in so far as the areas in question are fully awake 
and stimulated, just so far is the consequent 
dream vivid. And the wandering, discon- 
nected, and irrational character of dreams is 
due to the fact that the will and the reason are, 
under such conditions, in less than their usual 
state of control — the state that is known by the 
name of consciousness. And since the mental 
processes of young children are under less logi- 
cal restraint than those of adults, the dreams of 
children seem less unreal, partake more of the 
nature of actuality than those of mature per- 
sons do. Thus, one can easily understand that 
dreams have a real significance, that they mean 
imperfect sleep, and that if the physician could 
have a sufficiently profound knowledge of local- 
ization of cerebral action, he would be able on 
hearing the recital of the dream to describe the 
part of the brain which was involved, and even 



SLEEP 143 

the extent of its distribution. Perfect sleep is 
dreamless, unruffled, sweetly restful ; and if a 
child does not sleep in this manner, he has a 
right to demand — or, stated differently, the 
responsibility of the parents should stimulate 
them to seek — a searching inquiry into the 
facts of the case and an attempt to right what- 
ever abnormal conditions may be found. 

A sharply differentiated form of this partial 
awakening is familiar to everybody under the 
name of somnambulism. Here the brain is able 
to stimulate such a train of reflex action in the 
nervous system as is essential for progression, 
and at the same time the sense of muscular exer- 
tion, which is doubtless situated in the cere- 
bellum, is doubtless awake. Simultaneously 
that part of the brain whose function is to 
recognize impressions is not sufficiently awake 
to collate and know what is taking place. 
There is plainly a wide gap between the physi- 
cal experience of walking through rooms, down 
stairways, and out into the street, on the one 
hand, and, on the other, the orderly placing of 
memories, ideas, and conscious reasoning con- 
nected with them that characterizes such actions 
in times of lucid wakefulness. And when once 
the philosophy of these phenomena is clearly 



144 THE CARE OF THE CHILD IN HEALTH 

understood, there is always the possibility of 
sufficiently perfecting the ordinary action of the 
body so that it may work clearly, uninter- 
ruptedly, and peacefully. Dreams and som- 
nambulism are not the wild and wayward fancies 
that they are so commonly supposed to be ; on 
the contrary, they are as rigid and inevitable 
as any other manifestation of natural forces. 

The lesson of the whole matter is that one 
should not be satisfied with a child's sleep 
unless it is quiet, serene, and refreshing. Any 
interruption which occurs regularly or fre- 
quently should be investigated until the cause 
has been found; and then one should not be 
satisfied until the abnormal condition has been 
removed. For example, a child may snore, or 
sleep with an open mouth, or pick the nose, or 
talk incoherently, or throw himself about, or be 
tormented by depressing dreams, or awake with 
a feeling of exhaustion. Such things are com- 
mon, and always have an unfavorable signifi- 
cance. The cause may be adenoid vegetations, 
or an abnormal and devious nasal septum, or 
marked nervous irritability, or disordered di- 
gestion. But no matter what it is, it should 
be patiently sought for and finally corrected. 
Until that has been done, the little one cannot 



SLEEP 145 

obtain the rest and recuperation which he 
needs and must have. And negligence in this 
respect is more than mere carelessness ; for it 
means a deprivation of normal nutrition that 
may cause a life-long want of energy or 
strength. 



CHAPTER VII 



EXERCISE 



The subject of exercise, especially for chil- 
dren, is one that everybody believes in, but few 
follow out in a systematic fashion. Everybody 
knows that it is not only advisable, but neces- 
sary; and when it is neglected, the cause is in 
part carelessness and in part a halting appre- 
ciation of how widespread its influences are. 
Usually parents believe that exercise is a good 
enough thing, but that there is no special need 
for directing it, and that, in addition, children 
will regulate the matter for themselves. Besides 
all this, they commonly believe that the best 
way to dispose of a child's time is to fill the day 
as full as possible with the various duties which 
will adequately claim his attention and " keep 
him quiet," and trust to his ingenuity and 
natural lawlessness to assert the normal activity 
between times which all young animals inevita- 
bly possess. This statement may seem somewhat 

146 



EXERCISE 147 

crude and harsh : but if parents will look at the 
matter frankly, they will recognize that it states 
the matter with a reasonable amount of truth. 
In most households there is little or no intelli- 
gent attention paid to this subject, and in some 
the whole subject is consciously put aside 
because it seems too closely connected with 
what is coarse, gross, or violent. As a matter 
of fact, such a judgment is very far from the 
truth; it reverses the true relations of facts, 
and tends to dwarf one of the best aids which 
we possess for the development of a nicely bal- 
anced mental as well as physical equilibrium. 

We must clearly understand that every part 
of the body is susceptible of steadily improving 
activity. This is usually well understood in 
regard to the muscles ; but it is equally appli- 
cable to the bones, the nerves, and the special 
organs. One is very apt to think of the bony 
skeleton as being the foundation and permanent 
framework of the softer tissues ; but in reality 
the contrary is the fact. For by the strain and 
pull of the growing muscles the bones are pulled 
in one way and another according to the line of 
maximum force. During the early years, and 
until they have become consolidated by advanc- 
ing development, they are susceptible of an in- 



148 THE CARE OF THE CHILD IN HEALTH 

definite amount of change. The effect upon the 
nerves is equally great ; indeed, this influence 
cannot easily be overestimated. In many chil- 
dren these structures are exceedingly unstable, 
are subject to many variations in the way of over- 
excitement and a one-sided irritability. These 
effects may be evident at any age : the babe in the 
cradle may show them by restlessness, nervously 
disturbed sleep, nervously capricious appetite, 
and a deficient repose of disposition which can- 
not be attributed to a discernible organic 
disorder of the body. In older children the 
condition may show itself by bad temper, a poor 
adaptability to normal rules of conduct and 
self-restraint, and the development of abnormal 
characteristics. In some cases this may take 
the form of viciousness, in others, that of an 
uneven precocity or backwardness. While it 
is true that such conditions exist at times con- 
genitally, and are thus very hard to remove, it 
is likewise true that they may follow a con- 
gested, an impoverished, or an irritated state of 
the nervous system. 

Such a tendency is easily created by the 
necessities and the inevitable conditions of 
civilized life, especially in large cities. It is 
not hard to understand why this should be so, 



EXERCISE 149 

if we take into account the noise, the hurry, the 
forced restraint of school and drawing-room, 
the imperfect methods of ventilation and heat- 
ing, and the premature experiences that so fre- 
quently are the rule rather than the exception 
among a large proportion of growing children. 
When, in addition to these factors, the child's 
exercise is limited or badly arranged, the neces- 
sary metabolism or tissue-change must be cur- 
tailed or deflected from its rightful course, and 
the consequent development must as surely be 
more or less unnatural. The same train of 
reasoning is as applicable to the special senses 
as to the nerves and the muscular tissues. The 
sight, taste, hearing, touch, and smell are all 
capable of a gradual, healthy, and profitable 
unfolding; or they may become distorted, 
blunted, overexcited, or abnormal. And in 
order to help along the favorable and discourage 
the unfavorable course, a wise regulation of the 
daily exercise is of great help. Viewed in this 
way, exercise is more than a means to increase 
strength; it should rather be regarded as a 
necessity for the growth of normal activity. 

In infancy the sorts of possible exercises are 
limited, but, nevertheless, are adequate. The 
muscles and nerves are so weak and the control 



150 THE CARE OF THE CHILD IN HEALTH 

by means of the will is so rudimentary that 
more than this limited amount could not be 
endured. Nature has evidently taken this fact 
into account when she provided for the constant 
activity of a healthy baby, which takes the form 
of seemingly purposeless and random move- 
ments of hands and arms and body. Physiolo- 
gists translate this by saying that the centres 
of inhibition, which restrain and control mus- 
cular movements, are, in young babies, poorly 
developed or undeveloped; moreover, this 
development comes somewhat slowly and only 
in proportion to the growth of the whole body 
and its functions. 1 The inevitable result is 
that whenever the little one is awake he is 
unconsciously tossing his arms and kicking his 
legs about in order to strengthen their budding 
power. This shows a reason why his clothes 
should not be too long, heavy, and binding, 
why he should not be pinned and swathed up 
like a mummy. The little limbs must have 
every opportunity of unrestrained freedom for 
preparation against the time when he is able to 
put them to well-directed use. This exercise 
is increased by the unavoidable motion involved 

1 See "The Development of the Child," by Nathan 
Oppenheim. The Macmillan Company, 1898. 



EXERCISE 151 

in wheeling him in his carriage and carrying him 
about in one's arms. While such motion may- 
be gentle, it is, nevertheless, important, and 
compares closely to that which an invalid obtains 
when he is taken out driving or in a roller 
chair. The additional fact that this exercise is 
taken in the open air increases its value very 
much. Finally, the rubbing which he receives 
after his bath is of no inconsiderable impor- 
tance, and fills out the sum of his exercise. 
While these things are of salient importance 
for him, one should guard against exaggerations 
of them. As an instance, the habit of tossing 
a baby into the air, or throwing him violently 
about for the purpose of amusing him, is a case 
in point. The resulting disturbance may at 
any time be harmful, causing vomiting, 
diarrhoea, and lack of nervous equilibrium. 

As soon as the child passes the age of infancy, 
his exercise gradually becomes more varied and 
prolonged. While he is less than three years 
of age, it naturally consists of no more than 
being taken to walk, or being wheeled in his 
go-cart. And these should be done as much as 
possible in the air. In fact, the more of his 
time he spends in the air, the greater will be 
the likelihood of ultimate robustness. Out- 



152 THE CARE OF THE CHILD IN HEALTH 

side of the time devoted to the necessary factors 
of care, such as bathing, eating, dressing, and 
sleeping, the whole day should be spent out of 
doors. Thoroughly bad weather will naturally 
create an exception to this rule, although cold 
or cloudy days are too easily interpreted as being 
stay-at-home times. Heavy rains, winds, and 
snow-storms, or intense heat are the only reason 
for shutting children within four walls. And 
with increasing age the amount of time spent 
at home becomes progressively smaller. The 
three-years-old child may dig in the sand or 
the dirt, may make little caves and nests and 
the well-beloved mud pies. The mother should 
have no fear of dirt; she may allow him so to 
cover himself from head to feet, if he will. 
As long as he is properly dressed in stout, 
coarse slips, or even overalls, he is easily and 
rapidly cleaned when meal-time comes. 

At the age of five years the permissible range 
becomes much wider. If he is forced to stop 
indoors, light calisthenics and dumb-bell exer- 
cises may wisely be begun. If these are con- 
ducted with the accompaniment of a story, 
simple music, or concerted action, they become 
amusing as well as beneficial. Only the sim- 
plest motions should be employed. They must 



EXERCISE 153 

not be continued for too long a time, and under 
no circumstances ought they be allowed to in- 
volve strain. At this period the child may 
take longer walks in the open, and his carriage 
and manner of walking should, if necessary, be 
corrected. The habit of standing erect, walking 
with the toes turned out, and allowing the hands 
to hang easily, is formed more easily at this age 
than later on. The locality of the walks should, 
whenever possible, be selected in or toward the 
country or a park; and an earnest attempt 
should be made to familiarize the child with 
facts of nature. It is fully as easy to acquaint 
him with these facts as with those of the streets. 
Within a very short time this growing child 
may be taught to swim. In most cases a boy or 
girl of six years will learn the art more easily 
and quickly than those of fifteen; the younger 
child, if he has the advantage of example, is 
often more confident and more trustful than the 
older, and at the same time he is young enough 
to have retained some of the imitative faculty 
of the youthful animal. Swimming, if kept 
within reasonable bounds, is one of the best 
exercises that a child can have. It need not 
involve over-exertion, it brings all the muscles 
of the body into play, and the fatigue which it 



154 THE CARE OF THE CHILD IN HEALTH 

brings on may immediately be counteracted at 
any time by floating. While the child is in the 
process of learning, he should be taught to dive, 
to swim on his back, to swim when partly and 
wholly clothed, and to help a drowning person. 
At the same time he may be instructed how to 
support himself if he is seized with a cramp; 
but he must always be warned against remain- 
ing a long time in the water, for this is one of 
the commonest causes of such an accident. In 
most cases fifteen minutes are as long as he 
need remain in the water, while in the begin- 
ning of the season a shorter time is advisable. 
The common use of the bicycle has made this 
form of exercise familiar to young boys and 
girls. Children of six, seven, and eight years 
now freely indulge in it, and usually with 
benefit. There are a few suggestions in regard 
to its employment that may profitably be kept 
in mind. In the first place, a bicycle ride 
should not be too long in extent nor too rapid 
in rate. I have often enough seen compara- 
tively young children ride ten, fifteen, or more 
miles at a stretch at the rate of ten or more 
miles an hour; and in a number of cases I have 
treated them for abnormal conditions which 
thereby resulted. Bicycling, when thus carried 



EXERCISE 155 

to excess, should be regarded as violent exer- 
tion, and must not be participated in by any 
persons except those who are fitted, by strength 
and training, to withstand the strain. Rapid 
riding is apt to produce a tired condition of the 
heart muscle, with the attendant weakening of 
the circulation and liability to respiratory dis- 
orders. Another item is the height of the 
saddle and the plane of elevation in which it 
rests. When the child sits in the saddle with 
his legs extended, the lower pedal should touch 
the sole of the corresponding foot; and the pedal 
should support the ball rather than the instep 
of the foot. Very often one may have consid- 
erable trouble in adjusting the saddle, and the 
trouble comes, for the most part, from the irri- 
tation which the peak, or pommel, causes. This 
part, on account of the pressure which it exerts 
on the perineum, is the main objection to the 
ordinary commercial article, and should be abol- 
ished. If it is tipped up — a favorite position 
for many children — the weight of the body 
rests upon the perineum, and may injure some 
of the near-by delicate structures. If it is 
tipped down, the child slides forward, and must 
use part of his strength in supporting instead of 
propelling himself. The best position, there- 



156 THE CARE OF THE CHILD IN HEALTH 

fore, is when the saddle is quite level, and not 
too far back. If the saddle is thus arranged, 
if the bicycle is not too heavy, and if the handle- 
bar is high enough to make the child sit up 
fairly straight, the exercise obtained by this 
means will almost always be beneficial to a 
healthy boy or girl. 

An exercise that is usually recommended for 
its social and aesthetic, rather than health- 
giving reasons, is dancing. Nevertheless, if 
moderately practised, it may benefit the body 
in a variety of ways. Although the lower part 
of the body is the one most employed, never- 
theless the whole organism is, to some extent, 
brought into play; the finer movements and 
those used in maintaining an exact balance are 
especially brought out, so that while the circu- 
lation is being stimulated, and a healthy glow 
is made to pervade the body, the child's grace- 
fulness and lightness of movement are being 
developed. The fact that this exercise is gen- 
erally conducted under circumstances of fes- 
tivity and sociability gives the added advantage 
of keen enjoyment to it, and thus materially 
promotes its value. Besides all this, it maybe 
enjoyed by both boys and girls, and therefore is 
especially to be commended. There can be no 



EXERCISE 157 

greater mistake than the belief that dancing is 
a mere accomplishment whose purpose is no 
more than decorative. It is all this, but much 
more besides. Gentle exercise has its uses as 
well as that which is violent ; and especially for 
those children who are endowed with a large 
amount of animal spirits it may be exceedingly 
valuable. The necessary formality and court- 
esy which boys are forced by this exercise to 
show to their sisters and girl friends has an 
influence that is all for good. 

This fact brings to mind the limitations 
under which girls usually are placed in the 
attempt to gain a sufficient degree of strength 
and grace. At the same time, their need of 
vigorous exercise is fully as great as that of 
their brothers. The fashion of weak and help- 
less women has passed away, and we shall be 
fortunate if it never returns. A girl deserves 
as serious a preparation for future work and 
life as a boy ; and the fact that her work and life 
are to be different from his has no bearing upon 
the necessity for development. She can be fully 
as maidenly, sympathetic, and useful with a 
strong body as with a weak one; and in the 
favorable instead of the unfavorable condition 
she certainly will gain in health and strength, 



158 THE CARE OF THE CHILD IN HEALTH 

self-confidence, and ability to discharge her 
future duties as wife and mother. When she 
takes her exercise she must be properly and fitly 
dressed. Her skirts should not be too many, 
too heavy, nor too tight. Her shoes should be 
large, strong, and heavy enough to give an 
efficient support to the feet and ankle ; and the 
evil day when she is forced to wear corsets must 
be put off as long as possible. This article of 
dress is absolutely unnecessary for young girls 
whose physical development is such as to render 
constriction of the waist and support of the 
breasts superfluous. The evils that it may and 
very often does create are undoubted, and 
ought to be sufficient to impress a reasonable 
mind with their sufficiency. With abdominal 
and back muscles weakened, with abdominal 
and pelvic viscera squeezed and pushed out of 
place, a girl must inevitably be balked in her 
normal evolution and the attainment of her 
rightful growth. When the corset is replaced 
by a strong waist, without bones or stays, she 
is prepared to participate in many sports and 
exercises that are, for the most part, handed 
over to her brothers. 

In selecting exercises for children of ten or 
more years, those should be preferred that 



EXERCISE 159 

actively employ the mind as well as the body. 
For this reason fencing is highly desirable. It 
gives abundant movement, may be made as 
gentle or as violent as the capabilities of the 
person permit, and simultaneously develops 
the finer as well as the heavier movements, exer- 
cises the eye as well as the arm, and brings in 
the element of emulation. For somewhat simi- 
lar reasons tennis is a fine game, although it 
must be plaj^ed much more vigorously if the 
child aims to excel in it. Basket-ball is also a 
good game, and involves the very desirable 
factor of concerted action. This is a most use- 
ful element, for it develops a wholesome disci- 
pline, a salutary subordination to authority, a 
constant watchfulness to take advantage of 
opportunities. The so-called "team-play" of 
base-ball and foot-ball gives an undoubted value 
to those who play the game skilfully; and it is 
unfortunate that girls have not more amuse- 
ments which tend to further such qualities. 
The two games mentioned are thoroughly com- 
mendable for boys who have the requisite 
strength and activity ; but the spirit of strenu- 
ous striving must be brought out, and each 
player must be drilled to use determination and 
spirit, to work at every point in the game, to 



160 THE CARE OF THE CHILD IN HEALTH 

struggle and fight against defeat. Such 
reasons of personal influence make the train- 
ing that comes from sparring and wrestling an 
influence of much good. This influence stands 
for physical bravery, endurance, fearlessness, 
the careful estimating of an opponent's ability, 
as well as an increase of the body's strength 
and quickness. Such things are a real gain 
over the benefits which one derives from riding, 
driving, or even golf; although these sports 
have their value for the small number in the 
community whose wealth makes the item of 
cost unimportant. 

But whatever games are played must be par- 
taken of with the double object of the pleasure 
which they are able to give and the training of 
mind and body which they as surely provide. 
The parents should make the selection of these 
games and sports a matter of careful attention, 
they should participate in them (and thus 
obtain, in most cases, valuable training for 
themselves), and supervise them as carefully 
as they would select clothes to wear and books 
to read. When children of any age take their 
exercise, they should be properly dressed in 
strong, plain garments which they need not fear 
to soil or tear. Their sense of physical free- 



EXERCISE 161 

dom must be unrestrained, and they should be 
encouraged to let loose all the physical energy 
that characterizes the young animal. When 
their time of exercise is over, they should bathe, 
change their clothes, and adopt the more con- 
trolled manner of their ordinary hours. A 
rapid sponge or shower bath, followed by a 
brisk rub for a few minutes will bring out the 
appearance and feeling of bounding health and 
content, the enjoyment of a vigorous appetite, 
and the repose of a sweet sleep. 

In every home where children are there 
should be some substitute for a gymnasium; 
and whenever they are forced to stop indoors 
they should be encouraged to use whatever 
devices are at hand. Any room, whether it is 
an attic or bed room, nursery or play room, will 
serve our purpose. The only stationary fixture 
which we need is a pair of flying rings. If in 
addition there is a horizontal bar, a striking 
bag, or a set of parallel bars, or all of them, the 
opportunities for diversified exercises are much 
increased. Swinging clubs and dumb-bells are 
always easily obtained, and the use of them 
should be encouraged. All of these things are 
as valuable for girls as for boys, and both of 
them can profitably employ them at times when 



162 THE CARE OF THE CHILD IN HEALTH 

they may not row, skate, or disport themselves 
in other ways in the open. By all means every 
child must be made to feel that his body is as 
worthy of attention as his mind, and that the 
pleasures which may thereby be attained are 
both laudable and dignified. 



CHAPTER VIII 

CLOTHING FKOM THE TIME OF INFANCY 

There is a fairly well-fixed rule which con- 
trols the materials and the fashion of an infant's 
clothes; tradition and experience have settled 
what this may be, and the variations from it are, 
as a rule, small and unintentional. But as the 
child grows older and stronger, mothers feel 
that they have a wider range of choice, and a 
smaller need to adhere to a fixed standard. 
Moreover, the differences between the rich and 
the poor are then more plainly evident than in 
the younger children, not only on account of the 
rapidity with which clothes are outgrown, but 
also because there are so many fabrics on the 
market from which clothes are made. The 
belief has grown that the most expensive gar- 
ments are necessarily the most serviceable, the 
healthiest, and the best. Thus, indecision 
follows lack of information, and a certain 
amount of inconvenience, or even hardship, 
may be undertaken for the sake of a supposed 

163 



164 THE CARE OF THE CHILD IN HEALTH 

necessity to give a child certain costly kinds of 
garments. 

For such reasons it may be advantageous to 
consider what the various fabrics are and what 
work they are meant to do. Their main func- 
tion, outside of providing a decent covering for 
the body and furnishing decorative effects, is to 
afford protection against cold and heat ; and the 
main part of the problem consists in regulating 
the amount of heat which is given off from the 
body in cold weather. The importance of this 
question may be estimated from the fact that 
more than 80% of the heat which is generated 
in the body is given off from the skin ; and 
if additional inroads are made by badly selected 
clothing, the effects upon the health and vitality 
must necessarily be great. This dissipation of 
heat takes place through the well-known pro- 
cesses of radiation, conduction, and evaporation 
of moisture. Radiation acts mainly when the 
body comes in contact with cold objects, such 
as cold clothing, bedding, or furniture. Con- 
duction is most active when the surrounding 
air, whether it is hot or cold, is in brisk motion. 
Both conduction and radiation accomplish their 
purpose most thoroughly when the wind is cold, 
harsh, and strong. Evaporation stands for the 



CLOTHING FROM THE TIME OF INFANCY 165 

volatilizing of the moisture that is given off on 
the body surface ; in winter it amounts to very 
little, but in summer it may be considerable. 
The object sought for in wearing winter cloth- 
ing is so to regulate the factors of radiation and 
conduction that the body maintains its normal 
and comfortable amount of heat; and of these 
two factors conduction is the really important 
one. 

Common experience has demonstrated that 
wool is the best protection against cold, but the 
reason why it is efficient is not so well under- 
stood. There is much loose talk commonly 
heard about good conductors and poor con- 
ductors, that one fabric is "heating" and 
another "chilling." As a matter of plain fact 
there is very little difference between the 
organic constitution of the various fabrics as 
far as their power of conduction is concerned. 
Also, it is practically a matter of indifference 
whether the material is of animal origin, like 
wool or silk, or of vegetable origin, like cotton 
and linen. And whether the wool is one of the 
so-called "natural" or copyrighted articles, or 
the muslin is more or less finely bleached, is, 
for the most part a matter of indifference. The 
commonly heard argument that the " natural " 



166 THE CARE OF THE CHILD IN HEALTH 

wools are necessarily better than other brands 
because they tend to copy the state of nature 
involves striking fallacies; in the first place, 
we do not in our ordinary matters of life seek 
to imitate the ways of nature: we want our 
food cooked, not raw, as animals take it; we 
want to sleep in comfortable houses, not in the 
open ; we seek to be guided by reason, and not 
by instinct. Because wool comes from the 
sheep's back is no reason why it necessarily 
excels other fabrics as a means of protection. 
In fact, where the whole pelt is used, as in fur 
coats, much more warmth than is usual may be 
obtained by wearing the wool toward the body 
and the skin toward the weather. 

The real difference between the various fabrics 
consists in the way they are woven. If the 
material in question is so made that it con- 
tains a fairly large amount of air between its 
fibres, it keeps out cold better than if it were 
tight and smooth; for still air is an excellent 
non-conductor, and under such circumstances 
it serves a useful and active purpose. Here is 
where the true advantage of wool may be seen : 
for it is so made that its fibres are loosely com- 
bined, the rough ends protrude more or less, 
and touch the skin in a multitude of fine points. 



CLOTHING FROM THE TIME OF INFANCY 167 

As a result, there are strata of still air between 
the body and the cold. For similar reasons it 
is wise to have successive layers of thin cloth- 
ing rather than one very thick garment, even 
although the latter is equal in weight to or 
exceeds the weight of the combined suits. The 
method of dressing used by the Chinese is in 
this way highly to be commended, for they use 
the same kinds of garments in all seasons, but 
vary the number of them to suit the needs of 
the weather. If cotton, flax, and silk could be 
so woven as to present the same physical con- 
ditions as wool, they would also partake of simi- 
lar excellences ; if instead of being very smooth 
and tightly woven, they were rougher, looser, 
and possessed of more irregularities, their use- 
fulness as clothing would be equally great. 
Indeed, imitations of wool, which attempt to 
give the physical peculiarities of their proto- 
types, have been, and are, giving much satis- 
faction. And people with sensitive and irritable 
skins derive both comfort and benefit from fab- 
rics which are made wholly of cotton or of wool 
mixed with cotton or silk. 

In addition to this advantage of physical con- 
formation, wool has the fine characteristic of 
being able to absorb more moisture than cotton, 



168 THE CARE OF THE CHILD IN HEALTH 

silk, or linen. It is capable of taking up more 
than its own weight of water without immedi- 
ately losing its elasticity. Evaporation does 
not take place so readily from it as from the 
other fabrics mentioned, and, consequently, it is 
less liable when it is wet to chill the skin. On 
the other hand, woollen fabrics have a decided 
disadvantage in the way they react to washing 
and ironing. The action of washing and rub- 
bing causes the long, curty fibres to break, 
become hard and rough, so that the whole gar- 
ment is finally harsh, feltlike, and shrunken. 
While this can be in part avoided by care in 
washing, by the use of lukewarm or cool water 
in place of hot, and by waving the garment in 
the water instead of rubbing it, nevertheless, 
it is always more refractory in its conduct than 
cotton goods. The latter, on account of their 
lightness, their ease of manipulation, their 
smoothness, and the fact of conducting heat 
well, are the proper materials for summer 
garments. In the list of available fabrics for 
clothing, rubber cloth, oil cloths, oil silks, and 
mackintosh cloth should have no place. They 
prevent all beneficial movement of air, render 
evaporation impossible and create a chilled, 
clammy layer of moisture next to the body that 



CLOTHING FROM THE TIME OF INFANCY 169 

makes the probability of taking cold imminent. 
Finally, the comfort of the clothing can be 
modified to an appreciable extent by means of 
their color: for we know experimentally that 
certain colors take up more heat than others, 
and that this characteristic makes itself plainly 
felt in garments of different hues. Thus we know 
with certainty that black holds more than twice 
as much warmth as white, and that the interme- 
diate points are held by yellow, green, red, and 
blue. The exact order would read as follows : — 
White Bright red 

Light yellow Dark green 

Dark yellow Pale blue 

Pale green Black 

If we wish to summarize all these facts, we 
may say that winter clothing should be made of 
wool, or of mixtures of wool and cotton, or wool 
and silk that imitate the physical form of wool- 
len fabrics ; that they should be soft and downy 
rather than hard or feltlike; that they should 
be in thin, light layers rather than in one thick, 
heavy material; that they should not be too 
loose; and that their color should be red, dark 
green, blue, or black. In summer they should 
be made of cotton, muslin, or silk, should be in 
as few layers as possible, should be very loose, 



170 THE CARE OF THE CHILD IN HEALTH 

and that their color should be white, yellow, 
or pale green. Rubber material should never 
be used for clothing, nor should that fabric 
known as stockinet find a place in a child's 
underclothes, or mackintosh in his overcoats. 
" Waterproofed " woollen goods have less objec- 
tions to their use, for they admit of a moderate 
passage of air. In the future they will doubt- 
less be used much more than they have been in 
the past. 

The form of the clothing should be as simple, 
as light, and loose as a sensible regard for 
appearances permits. The general plan may 
with slight modifications be used for all ages up 
to the time of puberty. Thus, as soon as the 
child is old enough to have acquired habits of 
cleanliness, he may wear the so-called union 
underclothes; these as was stated in a previous 
chapter, consist of shirt and drawers united in 
one garment. For the autumn and spring a 
medium weight should be used, and for winter 
one may select either a heavy weight, or two 
lighter garments may be worn at one time. 
For summer the woollen wear may well be dis- 
carded for muslin or cambric; but in this event 
sufficient changes must be made to prevent the 
wearing of sodden clothes. The stockings in 



CLOTHING FROM THE TIME OF INFANCY 171 

winter should be woollen, long enough to reach 
well above the knee, and should have a fast 
black dye. In summer they may be of cotton, 
silk, or cotton mixture, and should be white or 
one of the light colors. The practice of having 
short socks on young children, which is unfor- 
tunately continued by some mothers into cool 
weather, should not be countenanced. The legs 
have the same reason for being covered as any 
other portion of the body, and may likewise be 
injuriously affected by inequalities of temper- 
ature, draughts, and other congestive influences. 
The same reasons forbid the exposure of a child's 
chest; and even in very warm weather it is 
advisable to have the whole body covered. 
There is no doubt that young children may 
suffer acutely from the heat, and every rational 
effort must be made to keep them as comfortable 
as possible. But this can be done by lessening 
the number, weight, and tightness of the gar- 
ments, instead of cutting out parts which right- 
fully should remain. 

Over the undershirt comes a waist to which 
the shirts and stocking-supporters may be at- 
tached. This waist is often corded for the sake 
of giving it a fairly permanent shape, and 
should be made of the various fabrics that be- 



172 THE CARE OF THE CHILD IN HEALTH 

long to different seasons. Thus, in summer it 
may be muslin, but it must be thin enough for 
comfort; in spring and autumn it may be made 
of coutil, and in winter two layers of light 
coutil or a sufficient thickness of flannel are 
desirable. This garment should be high in 
the neck and long in the sleeves, and may be 
fastened with good-sized buttons. In the lower 
band there should be a series of worked slits 
which resemble a buttonhole; and through 
them a strong and broad tape may be drawn, to 
which buttons are to be sewed. These buttons 
are meant to support the two little skirts, one 
of which should be of flannel, and the other of 
muslin, cambric, or nainsook. The weight of 
the flannel skirt must naturally be regulated by 
the season, and in very hot weather it may be 
laid aside. For ordinary children in good health, 
no abdominal band is at all necessary, and the 
use of it in summer may give an irritating feel- 
ing of heat and discomfort. Under the usual 
circumstances there is no more reason for wear- 
ing a knitted band on the abdomen than one 
over the lungs or about the throat. 

The outer garments come next in order, and 
require no special mention; for from what has 
been said the mother can easily deduce what 



CLOTHING FROM THE TIME OF INFANCY 173 

their requirements are. It is hardly necessary 
to say that young boys' knickerbockers should 
be buttoned on to the waist in place of the 
two skirts which girls wear. Boys usually 
wear a loose waist, or a sailor waist which has 
a deep enough fall over and below the waist 
line to hide all traces of band or buttons. All 
the changes which fashion and individual taste 
may suggest are usually harmless in their 
effects so long as they are not allowed to in- 
terfere with the characteristic necessities of 
proper material, ease, and looseness of cut, 
suspension of all weight from the shoulders, and 
absence of binding or constricting garments 
or appurtenances, as, for instance, in the way 
of garters. The round garter should never be 
worn, for its evil effects are peculiar to itself, 
while its advantages are better obtained by the 
suspension elastics which are fastened from the 
side of the waist. The clothing must be suited 
not only to the season, but also to the uses 
which it may be called upon to serve. Thus, 
in times of play, the child should wear such gar- 
ments as will not in any way interfere with his 
entire liberty of both mind and body. If he is 
daintily and expensively dressed, he will nat- 
urally be restrained in his running, jumping, 



174 THE CARE OF THE CHILD IN HEALTH 

falling, digging, delving, building, and number- 
less other exercises which are his by right and 
choice. Therefore his play-suit must be easily 
washable, strong, and with a fairly smooth sur- 
face. A good quality of denim answers the 
purpose excellently; and if it is made in the 
form of overalls, it will give much satisfaction to 
both parents and children. Little girls as well 
as boys may wear them, and the only change 
from the usual form that need be made is a 
widening about the waist and buttocks, so that 
the skirts may be tucked in and be well pro- 
tected. A child thus clothed has an exhil- 
arating sense of freedom; he does not fear to 
express all unrestrained effervescence that is 
characteristic of his age, and his possibilities of 
enjoyment are proportionately enlarged. In 
general terms, one may say that it is a good 
plan to use old clothes, as long as they last, for 
nursery use, for use in country and park. In 
cities, when children are allowed to go to a 
park, they are commonly overdressed or over- 
decorated; they may look more genteel or more 
prosperous, but they do not have as good a time 
nor do they derive as much benefit from their 
exercise as if they were plainly or even some- 
what roughly clothed. 



CLOTHING FROM THE TIME OF INFANCY 175 

A noteworthy part of the costume is the shoe ; 
for on the choice of it depends much of the 
child's activity, freedom of movement, and 
grace of carriage. It is a really remarkable 
fact that in this detail of clothing, which can so 
easily be properly planned and executed, there 
should be so many poorly designed articles. 
Nothing can be easier than to observe carefully 
the formation of the foot, to obtain its natural 
outline, and then to adapt the shoe to these 
elemental requirements. Nevertheless, a cor- 
rectly made shoe is not easy to find, and manu- 
facturers continue to make the same faulty styles 
that were in use many years ago. Even in a 
baby's shoe these misconceptions may be seen ; 
and whatever attempts at reform have been made 
are, in most cases, makeshifts. If one will 
blacken the sole of the baby's foot, and then 
take its imprint on white paper, one will readily 
see that it forms the approximate outlines of a 
triangle, the apex of which is at the heel ; more- 
over, when the foot is placed upon the ground, 
it has a tendency to spread out somewhat in the 
fashion of a duck's foot. From the toes and 
the fore part of the foot the fine motions of 
balancing are accomplished, and the carriage 
and walk are controlled. This part, therefore, 



176 THE CAKE OF THE CHILD IN HEALTH 

should have the maximum of freedom, if the 
function of the member is to be fully developed. 
In addition, until the muscles have obtained a 
useful measure of strength there should be as 
little restraint put upon them as possible. 
During the weeks and months while the child 
is learning to walk he needs all the aids that 
he can naturally obtain to help him in balanc- 
ing; and, therefore, a broad, flexible fore part 
of the foot is much more useful than a narrow, 
rigidly held one can ever be. Thus, one can 
easily recognize the need, during infancy, of a 
soft, soleless shoe, or "bootie," and during the 
period when the child is learning to walk, of a 
soft, loose shoe that is narrow at the heel and 
very broad at the toes — in short, one that is 
made and shaped like a moccasin. 

As the child grows older and his muscles 
grow stronger, he will, if he is in health, begin 
to walk of his own accord. And in almost 
all cases he needs no artificial helps or aids. If 
certain muscles, or groups of muscles, are unde- 
veloped or lacking in native strength, it is not 
wise immediately to use supports. The defec- 
tive muscles should be made strong by properly 
selected exercise rather than weakened by props, 
which take away the work that they ought to 



CLOTHING FROM THE TIME OF INFANCY 177 

do. There is no doubt at all that weakened 
functional activity can be strengthened by 
properly directed attention, and such is the 
proper method to be adopted. If the mother is 
not able to do this by passive motion, massage, 
and simple exercises, she should obtain the 
requisite information from an expert. For this 
reason it is unwise to use the so-called ankle- 
shoes, which have the paralyzing effect of a 
corset. They stifle the free play of the muscu- 
lar structures; and if the part eventually 
becomes strong, it is not on account of, but in 
spite of the artificial support. Naturally, this 
decision applies to cases of mere muscular weak- 
ness, and not to those of pathological deformity. 
With ankle-shoes and braces put out of the way, 
the shoe must be adapted to the form of the foot 
instead of the foot being adapted to the shoe. 
The sole should never be too thin, the front of 
the shoe must be very broad, the heel and 
counter should be reasonably small; the high- 
est part of the arch of the instep should be 
toward the inside of the foot, from which to 
the outer edge there is a moderately sharp 
incline. Such a shoe may not look decorative 
to eyes that are accustomed to sharp toes and 
broad heels ; but it has the greater advantage of 



178 THE CARE OF THE CHILD IN HEALTH 

being useful and comfortable, of giving a firm 
foundation for the sole, while it provides 
sufficient protection to the whole foot. 

The leather which is used in the making of 
the shoe should be kid, calf, or similar skin 
that is thoroughly porous. Patent leather, en- 
amelled leather, and other waterproof material 
should never be used. They make the skin 
wet and cold, tender and irritable; and their 
only extenuation is their decorative effect. 
High overshoes or rubber boots have a certain 
amount of justification because they are worn 
for no more than short and separated intervals, 
for during those times they adequately protect 
the feet from cold and moisture. But as soon as 
the child enters the house, they should be 
removed and the feet should be thoroughly 
dried. Before putting on rubber boots the feet 
should be covered with felt slippers. 

While a child's clothing should be comfort- 
able, becoming, and of a good quality, it ought 
never be too pretentious in style nor lavish 
in its decorations. A child should give the 
impression of unspoiled simplicity, should stand 
for a developing personality that is innocent 
and pure enough to be untouched by the garish 
vanity and class distinctions of the older world. 



CLOTHING FROM THE TIME OF INFANCY 179 

Not only do his clothes influence the estimation 
which other people form of him, but even more, 
they affect the opinion in which he is apt to 
hold himself. One of the best ways to make 
him vain, conceited, and petty is to overdress 
him, to fasten his attention on his external 
decorations. In this way such details come to 
take the place of an important ideal, and simul- 
taneously to exclude, in a proportionate degree, 
the growth of ideals of real value. A reason- 
able pride in decent and dignified dress is a 
good thing; the abuse of such pride is a very 
bad thing. The potentialities of a child are so 
great that interference with their best fruition 
should be undertaken with fear and trembling. 
A child is apt to seem pretty and doll-like, in 
all likelihood he is pleasing to the casual eye, 
when he is decked out in gewgaws until he 
resembles a lay figure ; but such characteristics 
fade away into woful triviality when one con- 
siders that in the bespangled breast may beat a 
heart of future greatness, and under the berib- 
boned cap may lie a brain that will give out 
large thoughts. If dress is the index of the 
man, it certainly has some influence in describ- 
ing the formative surroundings of the child. 



CHAPTER IX 



HABITS 



Matthew Arnold used to say that conduct 
was three-fourths of life. But he might have 
gone farther and said that all of conduct was 
contained in habit; indeed, he would have been 
strictly within reasonable bounds if he had 
claimed that habit constituted nine-tenths of 
life. It is the factor that controls both thought 
and deeds ; it takes the place that instinct holds 
in animals, and with every increase in the com- 
plexity of life it augments its power. We usu- 
ally think of it as the controlling force in a few 
of the Avell-settled customs of daily routine; 
but, as a matter of fact, its range of influence is 
infinitely wider. The manner of dressing, of 
washing, of eating, of walking ; the posture and 
carriage of the body, the peculiar character of 
physical expression; tricks of speech, the point 
of view that designates how conduct is directed, 
the decision which governs most questions of 
ethics, morals, and religion, all these and more 

180 



HABITS 181 

fall within the legitimate confines of that great 
force which we call habit. Many of the traits 
which commonly come under the heading of 
heredity and, practically, all of the effects of 
environment are really matters of habit. And 
it is often difficult to say whether any existing 
characteristics, outside of the organic conforma- 
tion, has not originated in the ceaseless repeti- 
tion of acts and thoughts that gradually and 
unconsciously changes impressions upon plastic 
infancy and childhood into the fixed and 
characteristic habits of maturity. 

The question of plasticity is an important 
one, and the younger the child the more impor- 
tant is the place it holds. For in such persons 
nothing is fixed, everything is potential. The 
brain is not in its mature form, it has not acted 
as the pathway of numberless nerve-currents, 
each one of which comes from one definite place 
and goes to another. According to the forces 
which may be brought to bear upon it, these 
nerve-currents may be sent in one direction or 
another, they may form various intersections, 
and they may assume various degrees of inten- 
sity and emphasis. Brain tissue follows the 
rule of all physical substances in being suscep- 
tible to certain impressions which, when indefi- 



182 THE CARE OF THE CHILD IN HEALTH 

nitely repeated, predispose the constituent 
particles of such substances to react in a definite 
and inevitable manner. Thus, a piece of paper 
that is once folded has ever afterward a tendency 
to fall into the same crease; and the sureness 
with which it falls into that crease is measured 
by the number of times the process is repeated. 
A piece of wood that is once polished is more 
and more easily made smooth and shiny — it 
has acquired the habit of being polished. A 
road that has been ridged by a heavy wagon- 
wheel has acquired the habit of containing ruts, 
and every similar impulse tends to make the 
ruts deeper and the habit more pronounced. 

In animals similar processes exist, but in 
greater complexity. Leaving out of account 
for the moment the factors of obvious training, 
we know that the whole organism may and does 
take on certain phases that, by reiteration, 
become permanent. A dog may become so 
accustomed to a certain sort of food that he 
will really faint from hunger, or even starve, 
rather than eat a different sort. A horse may, 
as a matter of routine handling, have been 
spoken to and soothed by the driver's voice and 
vocal expression, and if this method of control 
is suddenly altered, he may become uninanage- 



HABITS 183 

able and temporarily worthless. And in pro- 
portion to the place in organic development 
which an animal or person occupies, his organ- 
ization is plastic. Human beings, as a whole, 
have this plasticity in a marked degree, and 
most of all in their earlier months and years. 
Thus, an infant may be regarded as no more 
than a bundle of potentialities, which is another 
way of saying that his final, crystallized form 
represents a bundle of more or less firmly set 
habits. This crystallizing process begins at no 
exactly definite time. It certainly is in action 
directly after the child's birth, and may, in 
addition, begin before birth in the various 
degrees of the child's nutrition, which predis- 
pose him to receiving and interpreting certain 
nervous impulses. A baby may, on account of 
under- or over-nutrition obtain a corresponding 
ability to react to certain impressions, and this, 
in turn, may have an important share in the 
responsibility of building up his future life. 
Therefore, an attempt to shape the child's habits 
ought to begin with a wise and sufficient atten- 
tion to the mother during her pregnancy, or 
even before. 

At all events, after the little one has come 
into the world, the question of habit-formation 



184 THE CAKE OF THE CHILD IN HEALTH 

immediately becomes a burning one. Nothing 
can possibly be more important than it is, for 
it is a factor that is always active. This sweep- 
ing ideal must never lose its hold on parents' 
minds, and the more thoroughly they embody 
it and live it out in their conduct, the more 
deeply will they influence their children's 
development. They must be constantly on the 
watch for acts and tendencies that mark the 
beginning of a habit, and must as constantly 
be prepared to encourage the good and discour- 
age the bad. The start is the important thing, 
for more can then be done in one direction or 
another than at any other time of life. A clear 
conception of what constitutes good and bad 
habits must be formed, and then the conduct 
must, as far as possible, be made to square with 
that conception. And not only is such a course 
beneficial in regard to the particular matters in 
question, but also it has a definite use in pro- 
moting a disciplined and orderly budding out 
of the faculties that have been latent. 

For instance, one of the first things in the 
way of habits that a baby must learn is to lie 
quiet when he is awake and not nursing. The 
practice of carrying a child about, of tossing 
him in the air, of rocking and dandling him, is 



HABITS 185 

absolutely superfluous. There can be only two 
excuses for it: either the child is sick in some 
degree, and thus is restless and feels pain, or 
his relatives and attendants desire to amuse him 
and themselves by treating him as if he were a 
doll to be played with. If the first supposition 
is true, then he should without delay receive 
such medical treatment as will restore his 
health; if the second is the case, then the 
child is being trained to be restless, desirous 
of excitement, wanting in repose. These 
are some of the unfavorable characteristics of 
our time, and are responsible to no small extent 
for the wear and tear from which the modern 
person suffers. The custom of adding to the 
baby's tossing by making uncouth noises, pull- 
ing grotesque faces, and cutting capers in order 
to make him laugh is likewise unnecessary and 
doubtless harmful. To a child of this tender 
age everything is new, and the ordinary events 
of his little existence are certainly novel. The 
contortions and gymnastics that people com- 
monly believe amuse him must certainly be 
exciting for his small mind, must carry him 
away from the perfect restfulness which consti- 
tutes the best atmosphere for the full develop- 
ment of his body and mind. At this period of 



186 THE CARE OF THE CHILD IN HEALTH 

his life he should vegetate, he should nurse, 
sleep, breathe, and fulfil his primary physical 
functions. And everything else is beyond the 
mark. 

The circumstances of nursing and sleeping 
should be as simple and as natural as a due 
respect for sanitary and hygienic laws permits. 
Not only need he not be rocked to sleep, nor 
walked up and down the room to make him 
quiet, but also he should not be temporarily 
soothed by means of sugar teats, empty rubber 
nipples, rubber "comforters" or "pacifiers." 
The habit of using these articles is a thoroughly 
bad one, and should by all means be abolished. 
All infants possess the sucking reflex in so 
acute a degree that, as a rule, very little is 
needed to develop exaggerations and distortions 
of it. Thus, one may start some of the vicious 
sucking habits, such as finger sucking, clothes 
sucking, attempting to use any and every article 
for this purpose. By such means the fingers 
may become wasted and shrunken, and the 
mouth lose its shape; in addition, the habit 
of tongue sucking (doubling the fore part of 
the tongue back toward the pharynx and then 
sucking), or even tongue swallowing, may be 
thus encouraged. Possibly the most imminent 



HABITS 187 

danger of all is the likelihood of infecting the 
contents of the stomach and intestines with 
harmful bacteria. There is little doubt in my 
mind that a noteworthy proportion of the cases 
of summer derangements of these organs, of 
unexpected diarrhoeas and vomitings, and even 
some cases of bronchitis are so caused. For 
whether the child sucks on his fingers, or on 
the corner of a pillow, or a rubber "pacifier," 
or a home-made sugar teat, the result may be 
much the same: he takes repeatedly into his 
mouth articles that are not surgically clean, 
that may be polluted with pathogenic germs, 
and that, therefore, may threaten the child's 
nutrition, health, or even life. 

While such training is in its nature prohibi- 
tive and, therefore, negative, a bit of positive 
habit formation may be begun at a very early 
age. Most children, as a rule, do not develop 
habits of cleanliness until an unnecessarily pro- 
tracted period. This time often extends to the 
fifteenth month, the eighteenth month, and even 
the twentieth month. No mention need be 
made of children who do not obtain control of 
the bladder and rectum until they are two and 
a half or three years of age, for they are either 
pathologically deficient in control or suffering 



188 THE CARE OF THE CHILD IN HEALTH 

from actively bad training. One may find that 
the bladder sphincter is somewhat harder to 
train than that of the rectum; but both are 
sufficiently amenable to constructive teaching. 
If from the third or, at the latest, the fourth 
month the child be supported on the chamber 
vessel at regular intervals, and especially if he 
is held in the crouching position that is essen- 
tial to real ease in defecation, he will in a sur- 
prisingly short time respond in a satisfactory 
manner. These intervals should be decided by 
the approximate times when the spontaneous 
movements have appeared. At first it will be 
necessary to make the intervals at least four 
times a day; in a short time three will be 
enough, and, in most cases, the child will end 
by having two regular movements daily. Of 
course, one cannot expect success immediately 
in this any more than in other important 
matters. But a logical persistence will, within 
two or three months, give a gratifying result. 
To control urination will take a considerably 
longer time; although it is not hard to convince 
sensible parents, if they follow out the plan, 
that an element of regularity will soon appear, 
and that their work will thereby be lessened 
while the baby's comfort is materially increased. 



HABITS 189 

The habit of regularity should be employed 
in all the details of the day's routine: the child 
should awake or be awakened at a certain hour; 
his feeding must come at a definite time, and if 
at that time he is asleep he must be roused; 
the time of his bathing should likewise be fixed; 
his trips into the open air demand an equal care- 
fulness — in short, the child's whole life should 
be laid out by the clock. This will be his first 
lesson in obedience, which should represent a 
recognition of a necessary law of conduct. The 
question of obedience should have something 
logical in it, and the source of that logical 
quality must be in the demands of the parent. 
There is really no reason why parents should 
not be entirely logical in their demands ; even 
young children respond to a conscientious man- 
ner of forming one's opinions as well as to arbi- 
trary and thoughtless ruling. And if they can 
be subjected to some carefully ordered plan in 
the changing affairs of their daily life, there 
will certainly be less friction and commotion 
than otherwise. At all events, however, they 
must learn to obey; and obedience that comes 
readily and spontaneously is worth more than a 
tardy and partial compliance. They must from 
the very first realize that the controlling power 



190 THE CARE OF THE CHILD IN HEALTH 

resides in the parents, and that whatever power 
exists is being humanely and deliberately exer- 
cised. At the same time, they must know that 
humane and deliberate principles are thoroughly 
consistent with firmness. This firmness pre- 
supposes so much forethought, self-denial, and 
struggle against indulgent affection that it may 
occasionally be difficult to embody in action. 
But whether or no it is hard, it must assuredly 
be acted out. No child is benefited by over- 
indulgence, and most children find their best 
preparation for mature life in a consistent dis- 
cipline that demands unqualified obedience to 
reasonable rules of conduct. 

While the habit of obedience is a valuable 
one, it must not be expressed in such rigid 
forms as to lead to the evils of exaggeration. 
A child that is ruled and governed too much is 
apt to have a cowed and deceitful mind. The 
logical outcome is an imitation of the harsh 
qualities of cruelty and tyranny. Children, 
somewhat like savages, fall very easily into 
these vices, partly on account of thoughtless- 
ness, and partly because their faculty of imag- 
ination is not well directed. No matter what 
the nature of the predisposition may be, we all 
know that it exists. To restrain his tendency 



HABITS 191 

while conserving the normal amount of aggres- 
siveness and independence may be a difficult 
task; but no matter how difficult it is, it should 
be undertaken with as devout a sense of obliga- 
tion as the parents can command. A cruel 
child, although answering closely to a natural 
type, is, and must be, thoroughly offensive to 
the best aspirations of a civilized parent; and 
with every manifestation of such a tendency a 
definite retrogression from a laudable spiritual 
condition has been made. A healthy spiritu- 
ality is not necessarily God-given; its origin 
may be distinctly earthly. Not counting the 
cases of special predisposition toward it, the 
quality exists, in some degree, in all persons. 
Extraneous circumstances according to their 
nature encourage or discourage it. And one 
of the factors that most surely make it wither 
is the utter disregard for another's personality, 
which we call cruelty. 

Viciousness rarely appears in a single form, 
and an unfortunate habit is usually founded 
upon so many different factors that various 
related habits increase by a simultaneous con- 
struction. As an example, one may cite the 
close relationship between cruelty and cow- 
ardice. Some of the constituent factors of the 



192 THE CARE OF THE CHILD IN HEALTH 

former, such as seeking an advantage over per- 
sons who are unable to resist or defend them- 
selves, fear of discovery, secretiveness, and a 
disposition to evade consequences, are likewise 
characteristic components of the latter. In fact, 
the relation between the two is so intimate that 
the existence of one is often a safe indication 
of the other. As a matter of practical experi- 
ence, the habit of fear, of being cowardly, is in a 
normal child quite unnecessary. It grows from 
repeated impressions which are generally made 
upon the mind of the child for the purpose of 
enforcing discipline. To the charge of com- 
mitting this weak and vicious mistake, parents 
as well as nurses must often plead guilty. We 
are too much in the habit of attributing to the 
" ignorant nurse-maid " the practice of frighten- 
ing children by stories of ghosts, "the black 
man," "the boogy man," and the mythical 
policeman who is supposed to take bad little 
boys and girls away. And, as a matter of real 
experience, many mothers do the same thing. 
In addition they bolster up the habit by express- 
ing fears in their own person; and this leads 
to the same inevitable result. The woman who 
is afraid to go into dark rooms and places, who is 
afraid of the thunder or the lightning, who falls 



i 



HABITS 193 

into a paroxysm of terror at the sight of a mouse 
or a rat, who shivers and cries at the touch of 
a caterpillar or a beetle, who fears dogs, cats, 
cows, or other harmless animals, is much to 
blame in making her children timid, suspicious, 
weak-souled, and apprehensive. Cowardice 
and bravery may be congenital qualities ; but 
more often they represent an acquired tendency, 
a condition of mind that has grown up from 
small beginnings, a process of evolution that 
tends to become crystallized in the matured 
person, who finds himself unable to escape from 
the stigmata of early training. 

What is true of cowardice, of cruelty, of obe- 
dience, of regularity, is equally true of the 
other habits which lend distinctiveness to the 
individual character. Courtesy is taught with 
difficulty to grown-up children, and it is as 
hard to assume good manners after childhood has 
passed into youth as it is to acquire a clean-cut 
taste in regard to dress or household decoration. 
With most people the impress that is made upon 
them in their early years lasts for the greater 
part of their lives, and in many cases forever. 
They may, with the passing years, obtain 
worldly experience, they may acquire the polish 
which social intercourse and thought give; 



194 THE CARE OF THE CHILD IN HEALTH 

nevertheless, the common rule demonstrates 
that they rarely obtain the perfect ease, repose, 
and finished culture of manner which distin- 
guish the man who is born and brought up in a 
home of refinement and good breeding. The 
peasant's cottage may contain as many sterling 
virtues as exist in a house which has sheltered 
generations of scholars and gentlemen; but 
peasants come forth from the former, and gen- 
tlemen from the latter. We are too apt in the 
present day — the time of the so-called common 
people — to deride the advantages of birth and 
to exalt unduly the rough and ready manner 
that, fortunately enough, may sometimes go 
hand in hand with sterling and manly qualities ; 
but the fact remains that the habit of gracious 
and modest bearing, of sweet-toned and har- 
monious demeanor, cannot be put on like a 
garment. One must grow into it, one must 
incorporate it as an integral part of oneself, one 
must breathe it in as one breathes the air that 
cleanses the blood. 

Yet another habit that grows with the child's 
growth is his use of language, and the accent 
that marks his speech. As the parents talk, so 
will the child talk. The ear becomes so habitu- 
ated to certain sounds and inflexions, the eye 



HABITS 195 

becomes so used to certain motions of the lips 
and face, the muscles of the tongue and lips 
become so accustomed to certain movements, 
that they finally come to act in these ways as a 
sort of second nature. Parents who are scru- 
pulous of the exactness of their phrases, of the 
correctness of their grammar, of the purity of 
their expression, are providing a daily training 
that will be of invaluable assistance to their 
offspring. Colloquial speech must be taken 
seriously, for the child is unable to distinguish 
between good and bad usage. Slovenly Eng- 
lish is as good in his ears as exact English, and 
the only absolute standard for him is present 
usage. It is as easy in early childhood to 
obtain a large and carefully differentiated 
vocabulary as a small and undiscriminating 
one ; but the difference between the two in later 
life, when success depends to so large a degree 
upon spoken intercourse, is very great. In 
childhood the acquirement of language and its 
refinements is a matter of unconscious develop- 
ment; later on it is an act of conscious effort 
which consumes both time and energy. For 
such reasons parents must watch their words, 
the framing of their sentences, and the faith- 
fulness with which the words express their 



196 THE CARE OF THE CHILD IN HEALTH 

meaning, as they would their acts and the inter- 
pretation which children would naturally place 
upon them. 

So far we have been considering general 
habits, which have much to do with giving 
character to speech. In addition there are par- 
ticular and peculiar habits which, although they 
have a more individual bearing, are worthy of 
careful attention. The usual habit of speech is 
an approximately even flow of words which more 
or less closely express the child's meaning. 
But there are exceptions where the flow of words 
may not be even, or where they express little or 
no meaning. Some children have difficulty in 
uttering the syllables of words. The trouble 
is not plainly associated with particular sounds, 
but rather with the clear, sharp, and unob- 
structed attack with which syllables and words 
are begun and the continuity which binds them 
together. No more than the first sound is 
made, and this is repeated with growing rapidity 
and embarrassment as the speaker's nervous 
spasm increases; finally, the whole word may 
come out as if forced by a strong effort against 
an obstacle. This habit is what people call 
stuttering. It has no connection with defects 
of the speech organs, but rather should be 



HABITS 197 

regarded as a combination of nervous poverty, 
lack of self-control, and, in many cases, imita- 
tion. It has no more reason for existence than 
other habits of defective speech, such as drawl- 
ing, hurrying, senseless and wearisome repe- 
titions of sounds, words, or phrases, or the 
prolonged use of babyish pronunciations. The 
stutterer can be cured of his fault both easily 
and quickly, if he is taken in hand at the out- 
break of the habit. He must be made to speak 
slowly and evenly; he must, as soon as he starts 
to stutter, be stopped, quieted, and told to 
begin again. He must be faithfully drilled in 
repeating words and sentences until ease of 
speech is as inevitable as lack of ease formerly 
was. The parent or teacher must be patient, 
gentle, and persevering ; and outbreaks of tem- 
per will do more to confirm the bad habit than 
can be undone by half a dozen lessons. 

A related habit that is often confounded with 
stuttering is stammering. This shows itself in 
an inability to pronounce individual syllables or 
sounds readily and distinctly. It may be the 
result of imitation alone, but often that effect is 
augmented by nervous poverty and exhaustion. 
There may, likewise, be some defect or disability 
of the organs of speech which limits the func- 



198 THE CARE OF THE CHILD IN HEALTH 

tional activity. Thus, the child may have a 
tongue-tie, or hare-lip, and cleft palate ; or the 
pharyngeal tonsil may be hypertrophied, and, 
as a result, the normal development and shape 
of the nose and upper jaw may be arrested or 
deflected. This small list is no more than a 
part of what may exist, but it is capable of 
showing how varied may be the influences 
which interfere with ordinary speech. There- 
fore, when a child begins to stammer he should 
first be taken to a skilled physician for examina- 
tion and, if necessary, treatment. After that, 
one may begin with careful instruction in cor- 
rect speech. Instead of purely physical dis- 
abilities or the influence of bad example, there 
occasionally occurs a case of defective speech 
habit that is due to nothing except mental and 
nervous deficiency. As an example, one may 
take the curious phenomenon of echolalia, in 
which the child will repeat again and again a 
word or phrase that has happened to strike his 
attention. Such manifestations, and those more 
startling ones, like functional aphasia, should be 
immediately referred to the skilled specialist. 

In the same manner that a child may contract 
bad habits of speech, he may also learn unfor- 
tunate customs in other respects. At times the 



HABITS 199 

origin of them is mysterious, and their persist- 
ence is often equally noteworthy. In this cate- 
gory one may include the vicious practice of 
nail biting, the evils of which are so plain that 
they need no demonstration. The children 
who practice it are almost always nervously 
depressed, or even congenitally asthenic; and 
therefore, outside of any measures which one 
may adopt to discourage them, the broader idea 
of the systemic need of treatment should always 
be kept in mind. To paint the nails with 
bitter solutions in order to give a bad taste to 
them is good enough in its way, but it does not 
go as deeply into the matter as it ought, nor 
does it search out the root of the trouble. This 
attempt at a radical rather than a provisional 
cure falls in line with the main thesis of this 
chapter: that habits are the expression of 
repeated impresses upon the mind, and to make 
or unmake them one must steadily keep before 
one's eyes the fundamental laws of psychology 
instead of a merely unreasoning encouragement 
of this manifestation or an irrational dis- 
couragement of that symptom. 

The need of a definite plan is especially to 
be seen in such a deplorable habit as that of 
masturbation. This is an especially good 



200 THE CARE OF THE CHILD IN HEALTH 

example, because it must seem to everybody 
unnatural, destructive, and utterly vicious. It 
is more common than parents are usually will- 
ing to confess, and in many instances it flour- 
ishes for years before the mother discovers it. 
In many cases which have come under my notice 
the practice existed from a very early age, and 
some have begun very shortly after infancy. 
Such children should not be regarded as natu- 
rally depraved and vicious, nor should their 
unfortunate habit be hidden and left unex- 
plored. On the contrary, all the details and 
aspects of the case must be fully investigated, 
and a searching inquiry into the probable cause 
of the defect must be made. A mere forbidding 
of the practice or the infliction of a punishment 
is neither rational nor effective ; one can hope 
for much greater ultimate success if one will 
carefully and patiently try to pick out the factor 
that is making the undesirable impressions upon 
nerve-cells. In some cases it is a deformity or 
physical peculiarity, such as a long and tight 
foreskin in a boy, or an adherent clitoris in a 
girl; in others it is the bad example of vicious 
nurses or companions ; in yet others it may be 
some lesion in the central nervous system. In 
the first case, surgical measures will give relief; 



HABITS 201 

in the second, changed environment, firm but 
kind correction, and tireless watchfulness will 
be of distinct service; and in the third, medical 
treatment or the use of hypnotism may diminish 
or obliterate the evil. But in every case one 
of the main factors is the recognition of what a 
habit really is, as well as the earnest attempt to 
provide a cure that is as insistent and stead- 
fast as the impressions which it is intended to 
remove. 

If one would embody such an ideal in the 
standards that are placed before children, the 
benefit which they would obtain must be really 
great. The habits of persistence, of concentra- 
tion, of self-control, are unquestionably suscep- 
tible of being taught and being learned. And 
in most cases this method is the surest means 
of inculcating such characteristics. A few ex- 
ceptional persons may arrive at the same result 
spontaneously or by experience ; but as a rule, 
the most reliable way of obtaining desirable 
mental conditions is the slow and positive one 
of imitative habit. In the little affairs of a 
child, he can, in his small way, exhibit quali- 
ties that will in later times make him a better, 
stronger man than the average, and the world a 
better one for his having lived in it. There is 



202 THE CARE OF THE CHILD IN HEALTH 

no reason why his youthful disposition should 
be allowed to vacillate in its native unsteadi- 
ness; and at the same time these habits need 
bring no burden of crushing discipline upon 
him. On the contrary, if he sees these habits 
in his environment, in the characters of his 
parents and guardians, and in the applications 
of stories and tales to ordinary life, he will, 
unconsciously or sub-consciously, take them to 
himself as he takes any less laudable conceptions 
of conduct. The habits of a child or a youth, 
looked at from this view-point, are not entirely 
due to himself; and whatever praise or blame 
they provoke belong only in part to him. The 
parents and guardians are fully as responsible 
as he, and possibly more responsible than he. 
If he is industrious, law-abiding, and decent in 
demeanor, they may feel a reasonable amount of 
self-congratulation. If he is deceitful, lazy, 
and vicious, they should look well into their 
own lives for the controlling factors. They do 
only a part of their duty if their external life 
is what the world calls respectable while their 
private and intimate deeds and thoughts are 
faulty. A child cares very little about respect- 
ability; he is strikingly direct in forming his 
ideas and estimations. And what affects him 



HABITS 203 

most is intrinsic intentions rather than extrin- 
sic appearances. The care of a normal child 
consists of much more than providing shelter, 
food, clothing, and conventional instruction; 
fully as much, it includes the living of such 
lives by the parents as will approximate in the 
closest possible degree to the ideal which they 
hope to see in him. The parents must look to 
it that their days must be times of high think- 
ing, of clean and pure living, of strenuous en- 
deavor, of devotion to what they consider noble 
and fine ; for by means of their offspring they 
project their own individualities upon the 
world. They may be satisfied to have low 
aims for themselves ; but they have no right to 
impose similarly poor aspirations upon their 
child, and condemn him to a grovelling exist- 
ence. 



CHAPTER X 

RELATION OF PARENTS TO CHILDREN 

The proper care of a child is a method of 
higher education for the parents. The subject- 
matter is so various, the attention to details is 
so exact, and the self-devotion is so constant, 
that one cannot be far wrong in calling it the 
highest education. This standpoint, if logi- 
cally adhered to, will create a distinction 
between the poorer methods of rearing children 
that were in use in the past and the better ones 
toward which the thought of to-day is moving. 
In past times children were taught to regard 
themselves as being troublesome, stupid, with- 
out knowledge, judgment, or tact. The rule 
that children should be seen and not heard car- 
ried its crushing influence through all their 
little lives. They were excluded from family 
and social functions, they were allowed to take 
no more than a very small part in the domestic 
councils and confidences, and their personal 
affairs were deemed too unimportant to admit 

204 



RELATION OF PARENTS TO CHILDREN 205 

of much notice. In a word, they were made to 
feel that their existence demanded an excuse, 
and that assertion of their individualities was 
almost domestic treason. In families of limited 
means they were made to work beyond their 
capacity, and their duties were turned into bur- 
dens ; among the wealthy the custom of handing 
them over to the care of nurses and governesses, 
so that the parents saw little of them, and had 
less to do with their rearing, was almost univer- 
sal. If one looks at such customs objectively 
and frankly, one would think that children were 
some sort of semi-civilized animal, whose nat- 
ural wildness required strong measures for its 
control, and whose companionship was to be 
endured and not desired. 

We have come to regard these things some- 
what differently now. We realize that children 
are fully as human as their elders, that they 
have hopes and aspirations, fears and doubts, 
joys and sorrows, in much the same way as their 
parents. It is true that their lack of experience 
gives them a deficient sense of proportion, and 
that their ignorance of worldliness leads them 
to make curiously literal interpretations of 
persons and things. But these characteristics 
are in many ways advantages rather than dis- 



206 THE CARE OF THE CHILD IN HEALTH 

advantages. The children are placed in their 
parents' hands not only helpless, but also 
unformed; not only dependent, but also claim- 
ing progressively greater attention; not only 
possessing possibilities of good, but also possi- 
bilities of evil. The choice of these alternatives 
does not lie with them, but with the parents. 
The children must submit to whatever decision 
is made for them, and the unfolding of their 
lives depends upon the fitness of the father and 
mother to direct, encourage, and repress the 
various characteristics that have need of such 
control. 

In order to do this work, thoughtfulness and 
devotion are absolutely essential. Good inten- 
tions are a meagre foundation for the noble 
superstructure of requirements which the cir- 
cumstances demand. A woman might as well 
try to substitute good intentions for a knowledge 
of cooking when preparing a meal, or a man for 
the ordinary information of commercial forms 
when trying to conduct a business. Intuitive 
feeling and hearsay instruction are a poor 
enough makeshift for a knowledge of how to 
feed and clothe and dress a child ; but when they 
presume to dictate the manner of building up a 
definitely good relation between child and 



RELATION OF PARENTS TO CHILDREN 207 

parent, as well as the formation of a clear, 
healthy atmosphere in the home, the task imme- 
diately becomes greater than reasonable expec- 
tation can hope to see fulfilled. So long as this 
is true, there is an obligation for the parent to 
consider the subject in all its aspects, and to 
ascertain how far he must progress beyond his 
existing limitations in order to satisfy the 
rightful claims of the situation. 

First of all, he should consider what the child 
is, what he ought to become, and what are the 
means at hand to bring about the desired end. 
The little one comes unformed, unwitting of 
every fact of life, absolutely ignorant of what 
this world, in all its myriad manifestations, 
really is. These things and many more he must 
learn from his parents and the environment 
which they provide. What they are to teach 
him is not only what they have learned, but 
what they themselves are. And the environ- 
ment means much more than the apartments in 
which they live and the furniture which they 
use; in addition, it means the spirit which 
pervades the home, the intentions that lie at 
the basis of their action, and the self-control 
by which they maintain a nice equilibrium of 
heart and mind in all the varying and trying 



208 THE CARE OF THE CHILD IN HEALTH 

circumstances that are incidental to ordinary 
life. This conception includes within its 
bounds all people — the rich and poor, the igno- 
rant and the learned, the resident of the city 
and the dweller in the country. It embodies a 
truth of human nature which is so broad that it 
admits of universal application. By such a 
method of reasoning we arrive at a wide gener- 
alization, which is the beginning and the end 
of the art of wise parenthood: the influence of 
parents is the direct reflection of their lives and 
thoughts. Here is a field where deceit cannot 
long abide, where in the long run honesty 
counts for a quality of unlimited value, where 
sacrifice to a healthy ideahbrings its rewards in 
progressively increasing amounts. 

It is very hard to deceive a child, although 
he is young and simple. Indeed, even at the 
earliest age, and when he is far from being capa- 
ble of analysis, he shows a marked adaptability 
in receiving impressions. His plasticity is so 
great that it assumes the likeness of an active 
influence, as a sponge fills out with the water 
in which it floats. Therefore, the time to begin 
forming a child's disposition or character is 
really at birth, or even before birth. Do the 
parents wish him to be kind-hearted, gentle, 



RELATION OF PARENTS TO CHILDREN 209 

frank, and honest; do they wish him to be 
deferential to women, sturdy to the world, 
hearty and unselfish in his manner to compan- 
ions? Then they themselves must consider 
what these qualities are, they must incorporate 
them in their own thoughts and acts, and finally, 
they must demonstrate them in the big and the 
little details of everyday life. 

In order to clear the ground for more particu- 
lar considerations, another preliminary fact 
must be disposed of. The place and importance 
of the nurse-maid are commonly exaggerated. 
She is regarded as being more necessary than 
she really is, and, in the ordinary case, she is 
too much depended upon as well as too much 
courted. In the families of the poor, or those 
of ordinary means, the choice is made from the 
least experienced and helpful girls; for the 
parents believe that anybody is good enough to 
wheel a baby-carriage or carry the baby. In 
the wealthiest families a somewhat more sophis- 
ticated person is demanded; but the sophisti- 
cation usually concerns matters of externals 
rather than real fitness. It is undoubtedly true 
that the large majority of these servants have 
very little real fitness for their work. They 
have received no real and efficient training, 



210 THE CARE OF THE CHILD IN HEALTH 

they are commonly ignorant, and the most 
favorable thing that one can say for them is 
that they may be actuated by a decent amount 
of good intentions. The incongruity of the 
whole situation is remarkably striking: the mis- 
tress of the house will often assume the personal 
care and supervision of her fine china or a fine 
picture, and she would never think of putting 
a piece of old lace in the custody of a chance 
servant; but a child is evidently considered 
less valuable or less susceptible to injury. 
Since every mother naturally believes that her 
baby is the most precious thing on earth, the 
conclusion naturally follows that she does not 
realize how intimately he may be and is influ- 
enced by early companionship. 

This touches the very root of the whole 
matter: the child is susceptible to impressions 
of one sort or another from the earliest age. 
That is the time when the forming of his char- 
acter and his distinctive traits begins. The 
mere fact that he does not immediately demon- 
strate the effects has little to do with the case. 
An illustration of a similarly slow but sure 
effect may be seen in the unconscious growth 
of speech. A very young infant who hears a 
certain language or dialect is naturally uncon- 



RELATION OF PARENTS TO CHILDREN 211 

scious of its character is tic peculiarities, but, 
nevertheless, within a few weeks or months he 
begins with inevitable certainty to use that 
language or dialect. If this were the place to 
go into the discussion of the physiology of 
nerve-impressions, it would be no difficult 
matter to demonstrate how the same rule applies 
to the other factors involved in growth. And, 
without argument, any one can see that what 
is true of learning words and accent is, in a 
similar way, true of the elements of conduct; it 
is no more than another step to recognize that 
the elementary parts of conduct — the motives, 
feelings, and passions of the person — may like- 
wise be transmitted. And thus we arrive at 
the conclusion that the earliest companionship 
of a child is a matter of grave importance. To 
place such responsibility upon an uninstructed, 
uncultured, unthinking young girl is reckless ; 
it is wilful extravagance of the worst sort ; it 
means throwing away the opportunity of pro- 
ducing the highest results, of making the closest 
bonds between child and parent, and really 
invites' indifference, misunderstanding, and 
division of purposes to be permanent residents 
in the home. 

The care and rearing of a child are matters of 



212 THE CARE OF THE CHILD IN HEALTH 

such importance that the mother alone should 
be intrusted with them. It is not out of the 
way for her to take an assistant to do the rough 
work, the fetching and the carrying. But the 
personal part of the service belongs only to her. 
She is the one who will ultimately reap the 
rewards of good or bad training, and she is like- 
wise the one who must provide the essentials 
of that training. She must enter into the prob- 
lem so earnestly that her duties will at the 
same time be pleasures. Even if she were so 
abnormally constituted that parental love did 
not impel her to work out all the possibilities 
of the situation to their full extent, neverthe- 
less, there is a sufficient field for the exercise 
of finished powers of observation, of fertile 
suggestion, of ready tact, of logical reason- 
ing — enough to busy a thoroughly active 
mind. 

From the earliest months she must live with 
her child; she should wash him, nurse him, put 
him to sleep, take him in the air for his exercise. 
As he grows older she must provide and direct 
his amusements, from the earliest time, when 
every sound and sight are new facts to his 
unfolding senses, to the period when his pleas- 
ures and duties resemble those of adults. She 



RELATION OF PARENTS TO CHILDREN 213 

must guard him from careless or rough handling, 
must enforce a kind but firm discipline, must 
teach him to be dependent upon her more than 
upon any other person in the household. At this 
time the father cannot expect to take a large 
share in the baby's training, for the necessities 
of his business will keep him away during most 
of the little one's waking hours, and, in addi- 
tion, he cannot be expected to have the deft 
touch and the intuitive knowledge of an infant's 
needs that a normal mother possesses. But he 
can be of decided use in maintaining a quiet, 
peaceful, cheerful atmosphere in the home; he 
can give efficient help by keeping tempers 
unruffled and minds cheerful ; and, most of all, 
he can develop a spirit of courtesy, of sweetness 
of manner, even of chivalry. Such things are 
more than mere counsels of perfection; they 
should rather be called practical directions for 
the building up of strong nerves, normal bodies, 
and healthy minds. And the man who con- 
scientiously endeavors to embody them will find 
that they react upon him, and serve to ennoble 
his own disposition. 

When the child is old enough to run about, 
he should live a large part of the day in the air, 
and all confinement must be reduced to the 



214 THE CARE OF THE CHILD IN HEALTH 

minimum. To follow this idea to its fullest con- 
clusions, he should, if possible, be taken to a 
home in the country or the suburbs. While it 
is obviously impossible for the large majority of 
people to have a home in both city and country, 
it is plainly feasible for almost anybody who is 
sufficiently thoughtful of the interests of his 
offspring to reside where the houses are not 
packed together, where there is an abundance 
of air and light, where there is no continuous 
rumble and roar of a big city's traffic. The 
modern means of communication are so excel- 
lent that a man who works in the heart of a 
great city may reach his home outside of that 
city's limits without undergoing too much 
strain and exertion. People of limited means 
can live as well and as cheaply in the suburbs 
or country as in town, and at the same time 
have advantages of healthfulness, quiet, and 
recreation which can in no other way be ob- 
tained. The strongest objection that can be 
urged against a country or suburban home is 
the one of overcoming the city habit or the leav- 
ing of a social circle — both of which are of 
little importance in comparison to the benefits 
to be obtained by the change. 

After this matter has been settled, the parents 



RELATION OF PARENTS TO CHILDREN 215 

must make up their minds that the family must 
be united, not only in the sense of mutual affec- 
tion, but also in daily interests, in studies, in 
pleasures. Of all these items the one of pleas- 
ures most concerns the growing child. It 
stands, in his estimation, for the greater part of 
life, and by means of it his parents must come 
closely in touch with him. Many of their own 
amusements may have to be thrown over : they 
may go less to the theatre, may indulge less in 
social pleasures, they may have less personal 
quiet than they formerly had; but the exchange 
will be a richly profitable one. There is no 
reason why parents should not find as interest- 
ing material in their own children as they do in 
strangers or acquaintances; there is no reason 
why they should not take as lively an interest 
in the conversation of their offspring as they do 
in that of their neighbors or their ministers, 
their doctor or their lawyer. Often the little 
ones are not too deficient in the reasoning 
quality, and commonly they possess more than 
the adult share of lively imagination. At all 
events, parents can find in intimate intercourse 
with their children much to learn, much to 
stimulate them and keep them fresh, much to 
lend a zest to life. They can thus review their 



216 THE CAKE OF THE CHILD IN HEALTH 

youth, and, by combining the spontaneity of the 
little ones with their own more mature powers, 
they need have no fear of growing old, or of find- 
ing time hang heavily on them. 

To do all this there must be similar objec- 
tive points in the domestic life for the various 
members of the family. Each one must feel 
that there are certain duties and pieces of work 
which he must perform, and that every other 
one has obligations which are arranged accord- 
ing to his capacity. Children, even those of a 
very youthful age, can understand this to a sur- 
prising extent. In almost all instances they 
respond remarkably well to appeals, especially 
those which are made by conduct and example, 
rather than words, to their sense of justice and 
fair play. And, from the earliest possible time, 
each boy or girl must feel that he is a factor in 
the household, that he can and does render 
some sort of valuable aid, that he is a respon- 
sible person whose presence is worth being 
taken into account. The value of his actual 
work may be little, but that of his potential 
accomplishment is truly great. And no time 
is too soon to teach him to live on a high plane. 
Such teaching can easily and naturally be com- 
bined without any stiffness of attitude in the 



RELATION OF PARENTS TO CHILDREN 217 

ordinary affairs of the day. When the father 
returns from his work he may participate in con- 
versations, games, or readings in which he may 
ingeniously weave amusement and instruction. 
And if he feels that he has insufficient funds of 
thought and experience for the task, let him set 
out as a serious matter to obtain what is lack- 
ing. Children are tolerant critics, and fre- 
quently are satisfied with a wholesome intention 
even when performance is bungling. 

On half-holidays and Sundays he should be 
with his little ones in the open; in summer 
there are rambles in the woods, in the fields, 
along the roads, he may suggest fishing, flower- 
picking, butterfly-hunting excursions ; and 
many a time he will find that the questions 
which are thrown at him will encourage him 
to increase his store of knowledge. In autumn 
they may go nut-gathering, leaf -collecting. In 
winter there are skating, coasting, snow-ball- 
ing, the construction and manning of snow 
forts, and all the other sports that are dear to 
children's hearts. And in all of them he 
should take a hearty part, while at the same 
time he acts as a judge, a moderator, an ex- 
ample of fairness, of chivalry, and of courage. 
The girls as well as the boys should be his 



218 THE CARE OF THE CHILD IN HEALTH 

companions, and they need have no distinctly- 
separate lives until they are about twelve 
years old. They have as keen a need as their 
brothers for strong bodies and free minds, and 
until the approach of puberty they should not 
be too forcibly reminded of the difference in sex. 
This question brings up the weighty matter 
of how the parents may control the dawning 
knowledge of what sex is, and what the mean- 
ing of puberty is. In most families the subject 
is avoided, and both girls and boys are allowed 
to find out for themselves the changes that sep- 
arate the child from the youth. The main rea- 
sons which govern such a policy of laissez-faire 
are the parents' unwillingness from consider- 
ations of modesty to touch on the subject too 
prematurely, and the general unfitness which 
they usually feel to handle the details in a sat- 
isfactory way. The first reason is not well 
grounded, because the question of modesty con- 
sists largely in how the communications are 
made ; and no one doubts that a father or a 
mother will use much more delicacy, will try 
infinitely harder to give the requisite infor- 
mation, than servants, young companions, or 
chance acquaintances. In most cases when 
parents are forced to explain, they find that 



RELATION OF PARENTS TO CHILDREN 219 

their children have already a surprising and 
occasionally an appalling amount of knowledge. 
And the impressions which are the first to be 
received are commonly the last to be lost. The 
question of inability or unfitness to state the 
details is a more practical one, but it is by no 
means unsurmountable. A man or woman of 
fair intelligence, culture, and tact ought after 
some thought to be able to inform the child of 
how he is constructed, how his body and mind 
develop, and how the development fits into 
the scheme of nature. If this is impossible the 
family physician is usually able to supply the 
deficiency. Commonly he has a sufficient knowl- 
edge of natural history to give, in the course 
of a walk or a series of walks, a rapid account 
of the development of plants, with illustrations 
from the flowers and trees which he encounters; 
then to progress to the growth and generation 
of fishes, then of animals, and finally of human 
beings. And by the exercise of good judgment 
and a fair amount of delicacy he cannot only 
present the subject in a pure light, but also he 
can impress the child's mind with the idea of 
maternal self-sacrifice, devotion, and love which 
are the necessary factors of the mother's relation 
to her offspring. Thus, instead of this com- 



220 THE CAKE OF THE CHILD IN HEALTH 

munication being the cause of misgiving and 
dread, it may easily be turned into an oppor- 
tunity of cementing ties of affection and pro- 
moting in the child's mind the sense of life-long 
obligation. 

This is the spirit that should underlie the 
intercourse between parent and child, a spirit 
of carefulness, of frankness, of willing teaching, 
and equally willing learning. The child must 
under no circumstances be forced to feel that in 
any respect the full sympathy and cooperation 
of his parents are lacking. He must be made 
to believe that there is no concern so trivial, no 
secret so profound, no event so momentous that 
his parents are not the first to recognize and 
appreciate his emotions, his natural or acquired 
impulses, his triumphs and defeats. He must 
be made to feel that his home is the place where 
he is most welcome, where he can obtain most 
enjoyment. The opportunity of having fun is 
one of the mainsprings of youthful life, for it 
represents the possibility of the easy and pleasant 
discharge of youthful energy, of the exercise of 
expanding capabilities. Therefore it is in this 
direction that as much of the home life as possible 
should be directed; and at the same time the nec- 
essary duties which every person, according to 



RELATION OF PARENTS TO CHILDREN 221 

his age, should undertake must be so bound up 
with these pleasant features, that a flush of enjoy- 
ment spreads over the whole course of the day. 
It is not hard to apply the same plan to the 
companionships which every child is bound to 
make. Let him feel that his friends are wel- 
come, let him invite them to take part in his 
walks, games, and his rainy afternoons in-doors. 
The parents should become acquainted with these 
children, should exercise a wise choice among 
them, not so much by condemning some as by 
praising others. Among children even more 
than among adults the generalization holds true 
that those of like disposition and training will 
flock together ; for children have less of the 
ulterior and worldly to influence their choice. 
And if they are well directed, their companions 
are apt to be unobjectionable. At all events 
these friends are, as far as is feasible, to be taken 
into the family circle; they must be made to feel 
the heartiness of sentiment, the frankness, the 
lack of suspicion and prejudice that characterize 
the ideal home. They should be invited to par- 
ticipate in the games, rambles, and excursions 
that the children of the house enjoy, they must 
be encouraged to form clubs of various sorts, 
they must be instructed in what ways to direct 



222 THE CARE OF THE CHILD IN HEALTH 

their attention, and how to maintain a sense of 
good fellowship and chivalry. In all these 
enterprises the heads of the house must take 
part ; not for a single day may they allow their 
interest to flag. This last admonition is, in a 
way, unnecessary ; for if they have carried out 
such a plan during their children's early years 
the habit will have grown so strong, the enjoy- 
ment will have been so keen, and the freshness 
of their later years will be so striking that the 
possibility of adopting a different mode of life 
is barely possible. 

The gist of the matter lies in the doctrine of 
unselfishness. It is only by giving up the 
narrow, egoistic traits in one's character that 
one can develop a strong tendency toward gen- 
erosity in one's children ; it is only by extin- 
guishing whatever of the boor is in one that 
chivalry in one's offspring can be elicited ; it is 
only by crushing out the sullen and sulky parts 
of oneself that the full joy and beauty of life 
can be brought out in others. Children are 
exquisitely human, delicately sensitive to im- 
pressions, acute in detecting shams. And if 
one hopes to make them loving and lovable, 
respecting and respectable, brave and gentle, 
one must as a fundamental preliminary live out 



RELATION OF PARENTS TO CHILDREN 223 

these qualities in one's own life, and simultane- 
ously try to crush out their antitheses. A child 
may be deceived once or twice or thrice ; but 
he cannot be fooled for years; he knows and 
cares nothing about expediency, but acts out 
the thoughts and emotions which his environ- 
ment awakens. The parents are the head and 
the centre of that environment, their animus is 
the greatest force which forms the growing 
character, and their success as rearers of off- 
spring are usually to be measured by the intrinsic 
worth of their own souls. We have been told 
that men who desire immortality must, by a con- 
scious effort, throw off the characteristics of 
mortality; and it is fully as true that those who 
wish to live again in children of noble minds 
must first of all lose the traits which seem to 
wise men ignoble. This constant training in 
the search of an ideal is one of the finest things 
that human minds can conceive, this strenuous 
effort to stamp out the vicious parts of one- 
self is the real salvation in this world. It may 
be a good enough thing to try to save one's 
soul, especially if the saving be not too exclu- 
sive ; but it is far better to try to mould one's 
life so that one's children may be saved. The 
standard of effort has happily changed within 



224 THE CARE OF THE CHILD IN HEALTH 

the last two or three centuries. Men do not, 
as formerly, seek a selfish beatitude ; they have 
substituted for that a broader charity, a more 
inclusive love. And whatever they owe to 
their children is better expressed in terms of 
daily life and immediate home influence than 
distant deeds of valor and pauperizing obedience 
to heavenly laws which bear the smell of earth. 
It is a good thing to change the tense of our 
endeavors: to strive for present happiness and 
joy and love, instead of looking for some future 
bliss which stands out in a black background of 
others' damnation. 



CHAPTER XI 



EDUCATION 



Education, as we commonly know it, is a 
purely formal matter that is encouraged for the 
double purpose of conventionality and conven- 
ience. We take it for granted that every person 
should receive a school training ; that is the 
custom of the time, and unconsciously we con- 
cede the rightfulness of it. We likewise be- 
lieve it is a profitable thing to have, because it 
makes the possessor more capable of advance- 
ment in the world than he otherwise would be. 
The added reason of obtaining an education for 
its own sake, for the purpose of obtaining cul- 
tural influences, is often regarded as superfluous 
or at best as rightfully belonging to youth and 
adult life, and more especially to those persons 
of demonstrated ability or of fortunately large 
financial resources. Very often the cultural 
element is regarded as a detriment, because it is 
supposed to render the possessor less hardy and 
aggressive than he otherwise would be, and 
q 225 



226 THE CARE OF THE CHILD IN HEALTH 

therefore less able to fight his way through the 
world. Since there is plainly some error in- 
volved in these views, and especially as there 
seems to be no common factor which unites 
them, it is worth while to examine the subject 
and attempt to clear the way for the forming of 
more worthy opinions. 

The discussion rests mainly upon the ques- 
tions involved in what constitutes a desirable 
course of instruction, what is the age when 
instruction should begin, and what should be 
the order of the prescribed studies. All this 
takes for granted the elementary facts that all 
children need to be taught, and that the teach- 
ing of comparatively young children should be 
the same in all classes of society without regard 
to future work. For, whether the child is des- 
tined to be a banker, a merchant, a clergyman, 
or a bookkeeper, he needs the primary training 
which will serve to shape his mental growth in 
a healthful and profitable fashion. In consid- 
ering the present methods one is immediately 
impressed with the idea that with most people 
the first year or two of schooling are really not 
intended for any more serious purpose than to 
occupy the child's attention, and to keep him 
quiet. What he learns in the lowest primary 



EDUCATION 227 

grade is the merest conventionality, which, on 
account of his extreme immaturity, means abso- 
lutely nothing to him more than learning a cer- 
tain number of sounds by rote. Whether he 
learns the alphabet in the old-fashioned way or 
the phonetic sounds in the newer fashion, the 
same idea holds good. If instead of being 
started in the primary grades at five or six years 
of age, he is put in the kindergarten at three 
and a half, four, or five years, the same remark 
may truthfully be made. Children are sent to 
this latter institution to be amused, to play with 
others of their age, to be exercised in songs 
and games. The instruction — whatever there 
is of it — really is a secondary consideration. 
Indeed, that part which pretends to some merit 
in the way of formal instruction is least worthy 
of commendation. 

Since this has already been treated in another 
place l it need not be taken up here. It will be 
sufficient to say that if amusing the child and 
occupying his attention are the desired objects, 
they can best be obtained by the mother. She 
is the person who knows the little one most 
thoroughly, and she ought, more than any mer- 

1 "The Development of the Child," by Nathan Oppen- 
heim, The Macmillan Company, 1898. 



228 THE CARE OF THE CHILD IN HEALTH 

cenary person, to be able to sympathize with 
him, to recognize his needs as well as his pecul- 
iarities. The main objection that can be urged 
against her undertaking this work is ignorance 
of its technique. That objection is easily over- 
come by learning the principal practices of the 
kindergartnerin. This would not necessarily 
be a heavy task, and certainly it does not 
require the same amount of time that the learn- 
ing of a profession or a complicated business 
demands. On the other hand, if it is really of 
use in helping the child's development, its 
value is notably greater than any ordinary pro- 
fessional or business career. Under all circum- 
stances, the first years of a child's life should 
be spent in the companionship and under the 
control of the mother, who should endeavor to 
acquire sufficient training to give her confi- 
dence in her fitness for the work. 

This preparation should not be left until the 
child is old enough to attend the kindergarten, 
but rather should be acquired long before he is 
born. The mother must be ready to instruct 
her child as soon as he is susceptible of instruc- 
tion. This time is never fixed. In some chil- 
dren it begins at the age of a few weeks, in 
others when they are a few months old. At all 



EDUCATION 229 

events, it does not logically begin at the usual 
school age. There is only one way in deciding 
what the right time is, and that is by deciding 
what we mean by education. Is it to prepare 
the child to support himself, to give him the 
means to become a bread-winner? Then the 
training should come comparatively late, when 
his body, as well as his mind, is sufficiently 
matured to hold a recognizably approximate 
relation to its final and adult form. Is it to 
serve as mental training, to fit the child's 
intelligence for its later problems? Then 
the methods and curriculum must be changed, 
must be adapted to the stage of the child's 
development and his personal traits. Is it to 
amuse him, to keep him occupied and out of 
mischief? Then the widest liberty of choice 
must be the rule; rigid duties do not exist, 
strict teleological calculations are superfluous, 
and most of the routine of the ordinary school 
life is not required. In all likelihood the 
majority of mothers would not say that the 
earliest teaching was to be guided by any one 
of these plans, and probably they would be of 
the opinion that the training should include all 
three. 

But such catholicity is too comprehensive. 



230 THE CARE OF THE CHILD IN HEALTH 

It prescribes more than an ordinary child should 
absorb, or is able to absorb. We must recog- 
nize as thoroughly as may be that he represents 
a varying condition, a course in evolution from 
an almost rudimentary to a highly complex 
state. In his earliest condition the only teach- 
ing which should be given him is the teaching 
of precept and example. This is the time when 
he should learn the lessons of imitation, such 
as speaking one or more languages, funda- 
mental rules of manner, and elementary ideas 
of morals and ethics. Likewise, one may create 
a slowly growing, but really cumulative, effect 
in general aesthetics and in the growth of 
special tastes by arranging the nursery and 
the most frequented rooms of the house in ac- 
cordance with the impression that is desired. 
Formal instruction by the ordinary didactic 
methods should not be employed, and the habit 
of teaching babies to recite the alphabet, to 
count, to recite little poems and stories, has no 
good reason for justification. The common 
excuse that these things are not taught, but 
rather "picked up" by the child on account of 
his unusual aptitude is generally a figment of 
the imagination instead of cold fact. Very 
often it is possible that the mother may con- 



EDUCATION 231 

sciously not do the teaching; but if she does 
not, then the nurse or some relative does. It 
does not require much perspicacity to recognize 
that whatever teaching is to be done belongs in 
the earliest age to the creating of general and 
massive impressions ; there should be little or 
no attempt to particularize, to impart details, 
nor to elicit exactness. By setting an example, 
by creating an atmosphere which is honestly 
fashioned in the way we wish the child to grow, 
and by honestly endeavoring to embody in our 
everyday lives the ideal which we want the 
child to absorb, is the simplest and best train- 
ing for the under-kindergarten age. 

While the demands of the time do not allow 
the child to go without formal instruction of 
some sort, one should certainly keep in mind 
the tendency toward a premature beginning. 
This is to be feared for the double reason that 
many teachers are becoming disposed to accept 
children who are under the kindergarten age, 
and that some unwise parents want to see some 
educational result which the teaching is sup- 
posed to bring about. But at this early age 
very little excepting the most general employ- 
ment should be given. Games, songs, and con- 
versations may be very useful, especially if they 



232 THE CARE OF THE CHILD IN HEALTH 

are not too heavily laden with a didactic import. 
Attempts to explain the meaning of occupations, 
which the games may typify, are very apt to be 
useless, if only for the reason that the child- 
mind is unable to grasp the fundamental facts 
and necessities for them. The main objective 
point in the games and conversations is the 
directing of the imagination and the emotions 
within such limits as may define what mature 
persons call the normal, the righteous, and the 
generous. At the early age in question the 
child is probably receptive to such training, but 
scarcely to any other. His sense organs are 
not well matured, and with the passage of suffi- 
cient time they will develop far enough to be 
susceptible of keen cultivation. The apprecia- 
tion of the differences between colors, of various 
degrees of hardness and weight, of tenacity and 
resistance of one object and another, may well 
be left to a future time, to the experience which, 
comes with added years. And all efforts to 
develop the reasoning powers are yet more 
futile, for the fact of pure intelligence can 
scarcely be called existent in the brain which 
lacks many of the anatomical features that later 
in life are bound to appear. But the control of 
the emotions, conduct, and the imagination is 



EDUCATION 233 

an elementary principle that comes into being 
with the first flourishing of human life, and 
continues to a greater or less extent while life 
continues. This is the true function of the 
kindergarten, and if rightly administered it 
may be of the highest importance. The ability 
to restrain anger is infinitely more valuable than 
skill in passing colored wools through holes in 
a piece of cardboard; and learning to be cheer- 
ful, frank, and honest is not to be compared 
with ability to weave strips of colored paper. 
Teaching the motions which a blacksmith uses 
at the forge may be interesing enough, if noth- 
ing better is at hand; but it certainly is less 
valuable than guiding the mind by practical and 
interesting illustrations toward the beauties of 
filial and parental love, of the obligation of 
duty, of the excellences of normal subordination. 
The functions of the kindergarten are largely 
concerned with ethics. The relation of the 
child to society at large depends upon the ethi- 
cal sense of the community, of which he, in 
time, must form an active member. The task 
of acquiring a healthy, normal, ethical feeling 
is a difficult one, but it may be taught as surely 
as other modes of personal expression. The 
learning of such tendencies belongs to the period 



234 THE CARE OF THE CHILD IN HEALTH 

of early childhood, when the impressions which 
are most easily received are the general and 
massive ones. And while they are being 
acquired the child undergoes no danger of 
being harmed by a routine that is not fitted for 
the degree of his evolution. There is no pos- 
sible danger of straining weak eyes, of filling 
the immature head with temporary and ofttimes 
useless memories, or of giving to artificial edu- 
cational concepts the all-important place that 
really should be held by ideas of duty and 
dependence. 

In the primary school a notable change could 
likewise be made with advantage to the child's 
growth of mind and the amount of his informa- 
tion. Under the present circumstances the 
number of subjects in the curriculum is too 
great, the subjects themselves are not carefully 
enough selected, and their relative importance 
has not been rightfully determined. Parents 
have been going in the same path that their 
ancestors took, in believing that one subject 
was as valuable and as necessary as another, and 
that the knowledge which is desirable for a 
youth or an adult must likewise be desirable for 
a child. In this way the daily routine has been 
overburdened; and as the requirements of the 



EDUCATION 235 

times have increased, the increased load has 
been put upon the young child, the representa- 
tive of the weakest part of life. Thus, instead 
of lessening his work, the authorities, spurred 
on by a mistaken sense of duty, have been 
enlarging it. They have reasoned that because 
the man must know arithmetic, the young boy 
must as early as possible take it up; that 
because the one must know how to spell cor- 
rectly, the other must as soon as possible load 
his memory with combinations of sound that 
usually mean nothing to him; that because the 
former should speak correct English, the latter 
must be tormented with the abstract rules of 
theoretical grammar that never yet have made 
him see the error of his youthful speech. 

As a mattter of fact, the studies should be 
arranged according to the child's state of men- 
tal growth; topics which are beyond his years 
should be put to one side until such times when 
he is easily able to master them, and his general 
work should be made as inviting as possible, 
rather than the opposite. As an example, one 
may quote the case of arithmetic, probably the 
worst offender in the whole list. The intelli- 
gent study and comprehension of this subject 
are obtained only in the presence of considerable 



236 THE CARE OF THE CHILD IN HEALTH 

intellectual power of a certain sort. It repre- 
sents abstractions that are difficult to grasp; 
and it becomes of use, both as mental train- 
ing and as matter of information, only when 
it is plainly grasped as an abstraction. In 
all other circumstances the act of learning 
numbers, or arithmetic, is merely memorizing, 
— a parrotlike performance that is both weaiy- 
ing and debilitating. The child that begins 
to stud)'- arithmetic at five or six years of 
age really wastes both time and energy for the 
next five or six years. For if the subject were 
begun when he had reached the age of eleven 
or twelve, he would, under proper instruction, 
progress as far in one and a half or two years as 
he would under the other plan have taken about 
seven to accomplish. Here is a clear waste of 
time, but it is exceeded by the waste of mental 
energ}^, interest, and spontaneity, which is of 
much more account. 

Equal fault may be found with the studjr of 
grammar. It is too theoretical, too abstract, 
and, in addition, it exerts no influence on the 
scholar's language. It is a type of wrong and 
difficult methods of teaching: the use of the 
abstract before the concrete has been used and 
understood. A boy may learn every rule con- 



EDUCATION 237 

cerning subject and object, predicate and adjec- 
tive; but the language which he uses will be 
what he has been hearing. On the other hand, 
he may be absolutely ignorant of rule or excep- 
tion ; and in the same manner he will take his 
speech from the people with whom he passes his 
time. The children of cultured parents will 
speak correctly and with a good accent; the 
children of crude parents will speak incorrectly 
and with a bad accent. And a pile of grammars 
as high as a house will never change these 
facts. The only time when the study of gram- 
mar may be expected to do real good is when 
the student is old enough to have an active self- 
control and analysis, when his self-conscious- 
ness is great enough to restrain his acts, speech, 
and even his thoughts. Then, when pride is 
awake and ambition is stirring, when self-inter- 
est has aroused all the energy of endeavor, the 
study of grammar may be both profitable and 
useful. In earlier times it is, like arithmetic, 
as useless as it is burdensome. 

In all likelihood the conservative reformer 
may find fault with the use of the spelling- 
book. The learning of the literal composition 
of a word is a form of memory which is made 
up of repeated visual and auditory impressions. 



238 THE CARE OF THE CHILD IN HEALTH 

Such impressions are most easily received and 
retained if they occur in connection with known 
facts and ideas, such as are obtained in the 
course of reading an interesting narrative; and 
the hardest way to acquire them is the bare and 
unassociated act of memory. The act of learn- 
ing the appearance of isolated words and memo- 
rizing the separate sounds that constitute them 
is a thoroughly laborious one ; and the results 
do not justify the expenditure of time and 
energy expended. If this study were postponed 
until the faculty of observation had been fairly 
well exercised, and until experience in reading 
had made a comparatively large number of words 
familiar to eye and ear, the process of knowing 
how those words looked and sounded would be 
much more easily and rationally acquired. If 
we follow such a method of thinking to its ap- 
plication in other directions, we shall be forced 
to lay less stress than we now do on the early 
teaching of penmanship according to a rigid 
copy. When the fingers and eyes are inexpe- 
rienced and weak, the recognition of the essen- 
tial points in writing are apprehended with 
difficulty and expressed very poorly. More- 
over, minute and slavish copying is hard on the 
young child's undisciplined faculties. There 



EDUCATION 239 

is a general rule in human development which 
covers the fact that the inhibitory centres are 
among the latest to attain flourishing strength; 
if this idea is translated into more common 
phraseology it might read: the power to restrain 
comes later than the ability to act or express 
motion. This statement corresponds to the 
common experience of children in the hardship 
of exact imitation of a small copy. Not only 
theoretically, but also practically, it would be 
easier for a young child to learn to draw simple 
and large objects free-hand than to acquire 
facility in neat and graceful writing. 

The study of geography is taken up too early 
in the routine of school work; and, as a result, 
the effects which it produces upon the ordinary 
child's mind is a confused one, a matter of ill- 
assorted patches. A young boy or girl is un- 
able to appreciate the striking nature of the 
earth's rotundity, of the correct inter-relation- 
ship of parallels of latitude and longitude as 
depicted on maps, of the physical disposition 
of land and sea. The usual plane maps mean 
very little to such a scholar, whose imagination 
is not sufficiently trained to translate the plane 
surface into terms of the shape and form of the 
earth. The boundaries of the various coun- 



240 THE CARE OF THE CHILD IN HEALTH 

tries are learned as rigid divisions, in the 
same artificial way that one house is marked 
off by its walls from another. No efficient 
means are generally used to convey a satisfac- 
tory conception of these political communities, 
their distinctive traits, their resources and in- 
dustries, their physical relations to one another, 
and the main facts of information concerning 
their peoples. The true view of a country, in 
the light of its organic growth, is practically 
never held by young school children. 

It is easy enough to verify these statements. 
In order to do so parents should occasionally 
visit their children's classes. I have done this 
fairly often, and have always had profitable 
experiences. One of the occasions which im- 
pressed me was a visit to a public school in 
New York City, where I listened to a boy of 
about eight years, who, in the course of his 
recitation, said that Pennsylvania was the 
capital of Philadelphia, and that George Wash- 
ington was "a brave British general." When 
the teacher was asked whether that was a 
type of all the recitations, she retorted, " What 
can you expect of a child of eight ! " At 
other times and in other schools I have heard 
recitations that were no more exact, and I have 



EDUCATION 241 

always murmured to myself the exclamatory 
quotation given above. Although the illustra- 
tion may seem an extreme one, nevertheless, it 
does not misrepresent the mental condition of a 
large part of the primary scholars in regard to 
this subject. In some respects it is character- 
istic of what an observer will meet in most of 
his visits. 

Geography, then, like the other studies men- 
tioned, does not belong in the curriculum of the 
primary grade. But, if it is to be retained, its 
present form and method of teaching should be 
altered. It would be quite in place to teach 
young children what the physical divisions of 
land and water are, what the differences in cli- 
mate are, what the characteristic occupations 
and manner of life are that belong to each, and 
what sort of people is to be found in each. All 
this should be taught in a practical fashion 
rather than by words alone. If a large room 
were fitted up to represent continents, islands, 
peninsulas, oceans, lakes, and rivers; if the 
different zones were depicted in gross present- 
ments with satisfactory examples of their inhab- 
itants, their occupations, the fauna, the flora, 
and the distinctive geological formation, the 
child's mind might be pleasantly occupied, — 



242 THE CARE OF THE CHILD IN HEALTH 

as it would be with a story, — and some funda- 
mental information might be imparted that 
would require comparatively little discrimina- 
tion, little rote memorizing, and almost no 
fatigue. Upon such a foundation a solid 
superstructure of geographical information 
might be built when the child is twelve, thir- 
teen, or more years of age, which would be 
durable and at the same time easily reared. 

If the ordinarily intelligent parent will take 
the trouble to examine the course of study in 
the primary grade, and if he will allow himself 
to think fearlessly and unrestrainedly, he will 
soon be convinced that many of the studies may 
not only without detriment, but also with bene- 
fit, be dropped. And when he has reached this 
conclusion, he will invariably want to know 
what is to fill the gaps. This is not hard to 
decide upon, so long as the general condition of 
the child is understood. One must keep in 
mind the scholar's disinclination to bear long- 
continued restraint, his lack of concentration, 
lack of mental self-control, his inability to deal 
with abstractions, the lack of the reasoning 
faculty, his deficient store of memories and as- 
sociations, and his love of novelty and change. 
All this would require the teaching to be as little 



EDUCATION 243 

formal as possible, "would diminish the desira- 
bility of rigid recitations from memory, would 
increase the amount of narrative work, and of 
instruction that was susceptible of the story- 
telling form. Languages that were taught by 
the so-called natural method wxmld have a more 
important place, and would be taken up at an 
earlier age than is now the custom; and all 
studies that could be prosecuted in the practical 
manner which was suggested when speaking 
of geography, would have a welcome. In addi- 
tion, some studies should be held out of doors, 
or on roof-gardens, with which schoolhouses 
could easily be provided. The teaching should 
be made a pleasure, a form of instructive recrea- 
tion, of useful pastime that involves movement, 
frequent change of occupation and subject, and 
of the vigorous exercise of the imagination. 

In this connection it is pertinent to speak of 
the ethical and religious, as well as the so-called 
common education ; for it is hard to separate the 
three, unless one means creed when one says 
"religion." Ethical training may be regarded 
as defining the attitude which a person holds 
toward his fellow-men; religious training as 
defining the attitude which he holds toward the 
Deity or his conception of the Deity. The one 



244 THE CARE OF THE CHILD IN HEALTH 

is a material relation illumined with a spiritual 
glow, the other is an expression of a spiritual 
effort that is dulled and weakened by the mate- 
rial self of the believer. Both are modes of 
projecting the personality, of expressing a men- 
tal impulse which varies according to circum- 
stances of environment and opportunity — 
possibly of natural disposition. Both have a 
soft and mellow hue which at times makes it 
hard to distinguish between them; and under 
all circumstances the penumbra which they 
throw impinge upon one another, causing a 
blending which cannot be called by one name 
or another. Under such an aspect they are 
admirable, most of all when they originate in a 
spontaneous or purposeful movement of one's 
mind, which is no more than a reflection of one's 
best intentions. 

Unfortunately, the usual interpretation of 
religion does not very closely coincide with this. 
On the other hand, it is often no more than a 
hard distortion of it, which involves many 
unfavorable traits in its developed form. And 
the mental attitude of a child is such as to show 
these unfavorable traits in a repulsive light. 
The child is unable to grasp the full spiritual 
import of religion, he sees none of its possible 






EDUCATION 245 

excellences of typification, none of its poten- 
tialities of endeavor, none of the opportunities 
of restfulness, of hope, and of satisfied longing. 
Instead, he grasps no more than a complicated 
system of admonitions and commands, which is 
commonly exercised with the expectation of 
possessing a correctional value. The behests 
of religion are for him negative in their nature : 
they prescribe what he may not do ; and even if 
they are put in a positive form, they stand for 
the negation of what he wants to do. His idea 
of the Deity is a purely anthropomorphic one. 
He conceives of God as a huge man whose power 
to punish bad children is frightful, and whose 
promise to reward good children bears no imme- 
diate likelihood of fulfilment in a form that is 
appreciable. As a result, the control which 
such an influence comes to have over him may 
be aptly compared to the terror inspired by a 
threat to call the "black man," the "big police- 
man," or the "boogy man." It is a low form of 
suasion, a confession of inability in the parents 
to control their child's behavior, and a reliance 
upon means of restraint that are equally deroga- 
tory to them and debasing to him. The forms 
of religion he regards as a mere show or display, 
to be put on the same plane as any other exhi- 



246 THE CAKE OF THE CHILD IN HEALTH 

bition that is attractive when it is novel, and 
tiresome when it is no longer new. For him 
the rite of baptism holds no meaning, the eleva- 
tion of the host — a deeply impressive ceremony 
— carries no significance; he sees the accom- 
paniments of fine buildings, notable congrega- 
tions of men and women, and the imitation 
by all of a formula which he cannot under- 
stand. 

This factor of imitation is one of the main 
traits with which we must reckon in our efforts 
to produce a commendable moral or spiritual 
tone. This plainly does not apply to the teach- 
ing of a creed; for such a matter has no uni- 
versal truth or fitness. The teaching of one sect 
is fully as likely to be desirable or undesirable 
as another. And a formula that fits the needs 
of one person may bear quite the opposite re- 
lation to his brother or his neighbor. More- 
over, we can never know whether the creed 
in question has a final value in the potential 
development of a certain child, or whether it 
may not act as a hindrance to him, whether 
it is not an artificial creation which, in later 
years, may provoke the sentiments of rebel- 
lion, distrust in his estimate of his parents' 
honesty, and discord with the whole idea of 



EDUCATION 247 

spiritual control. But in the sphere of ethics, 
of pure morals, there exists a field for instruc- 
tion that is perfect in its possibilities. It is 
applicable to every family, to every community, 
to every nation. It is the standard of conduct 
by which the civilized world marks its progress 
from a lower to a higher grade of organized cul- 
ture. Above all, it is a code which applies as 
well to the ignorant as the enlightened, to the 
adult as to the child, to all creeds and all 
peoples. It is the gist of all religions, without 
which they represent no more than a mere shell 
that is hard, unyielding, and unpalatable. A 
child may be unable to appreciate the esoteric 
symbolism of the immaculate conception, or the 
Trinity, the doctrine of total depravity, or the 
regenerating power of baptism; but he surely 
is capable of knowing the import of the golden 
rule, of mercy, of charity, of good intention, of 
honesty, and of kindly deeds. He may be infi- 
nitely far from highly appreciating the worth of 
a torturing hell, of infant damnation, of escha- 
tology, of demonology, or angelology; but he 
certainly, and without much delay, can recog- 
nize the power of virtue, of forbearance, of 
loyalty, of truth, and of modesty. The one is 
an abstraction which belongs to a later age, 



248 THE CARE OF THE CHILD 1ST HEALTH 

when the reason should make its choice of 
beliefs that are to act as the immaterial guide 
to a definite tendency of spiritual life. The 
other is or may be represented as a concrete 
formation of acts that may be learned as any 
other method of conduct, the repeated perform- 
ance of which inevitably tends to create a 
mental condition that is its analogue. 

And one of the principal advantages of such 
training is the necessity of the parents and 
guardians to live up to a similar standard. 
Such conduct is learned by example and prac- 
tice more than by preaching. A man may be a 
pillar of the church, but if his daily life is not 
entirely in accord with his theoretical profes- 
sions, he will create upon his child the bad 
effect of insincerity in place of the desired 
effect of holiness. This is undoubtedly at the 
root of the strange and seemingly unnatural 
deviations from a much emphasized plan of life, 
which every one has noticed in the families of 
certain ministers and other pious people. The 
parents may be good enough men, as men go ; 
their professions and public acts may be highly 
commendable, and to the eyes of their little 
world they may seem to be models of thought 
and action. But in their private and intimate 



EDUCATION 249 

lives one usually may find the elements of cant, 
of insincerity, of make-believe, of a weak grasp 
on material and immaterial things, of mild 
regrets and halting endeavor. 

This brings to a clear focus the idea of edu- 
cating a child. It is not necessary to cram his 
head with many facts, most of which he cannot 
use, and for which he is not prepared. Nor is 
a rigid curriculum, which may merit our respect 
on account of its antiquity, necessarily the best. 
Most of all it is futile to gauge a child's needs 
by an adult's. The child's business is no more 
than to prepare for his work and his struggles 
in life; but the adult's is to grapple with the 
work and the struggles in an aggressive, mas- 
terful, and intelligent manner. The best 
foundation for an efficient training is the pos- 
session of a vigorous mind and body that have 
not been divorced from their native strength by 
artificial methods which have been devised upon 
a misapprehension of what the child's condition 
really is. The child should not be forced into 
a Procrustean mould ; rather he should be nour- 
ished, he should be strengthened, and his bud- 
ding functions should be guided within the 
limits of their own natural channel. His imi- 
tative faculty must be used instead of his 



V 



250 THE CARE OF THE CHILD IN HEALTH 

reason ; for the former is present from the ear- 
liest age, while the latter is the gradual growth 
of his later development. The education of a 
child, considered from this standpoint, means 
the continuous education of every member of the 
whole race. It stands for the development of 
every better feeling of which man is capable, 
of the self-restraint that marks him off from 
lower orders of animal life, of the hope, and the 
living in the future, that is an index of his best 
aspirations. The true teacher is the parent, 
who should be as unwilling to resign this func- 
tion as he would to lose his most precious birth- 
right. Parenthood includes within its wide 
confines the teacher's place as surely as it 
includes the generator's, the protector's, and 
the advisor's. And too much may not with 
safety be left to bought assistance. 



CHAPTER XII 



DEFECTIVE CHILDREN 



It would be out of place in a book on the care 
of the normal child to describe and discuss all 
the marked deficiencies which exist in idiocy, 
insanity, and radical perversions from the nor- 
mal; but between the two extremes there are 
a large number of degrees of imperfection which 
are commonly misunderstood, neglected, or hid- 
den. Indeed, one might truly say that parents 
can have no logical idea of what a normal child 
is unless at the same time they possess some 
knowledge of what is meant by abnormality. 
This is a matter in which the greatest frank- 
ness should be used; for in order to correct 
the deficiencies, one must thoroughly under- 
stand their causation, nature, extent, and 
probable outcome. It is undoubtedly true 
that most families that have a deficient child 
hide the fact as much as possible, believing that 
by such means they are preventing the outside 
world from interfering with his future work 

251 



252 THE CARE OF THE CHILD EST HEALTH 

and prospects. Most of all, they fear that the 
reputation of having a defective in the family 
would interfere with the estimation in which 
the world holds the other children, would 
diminish their opportunities of forming advan- 
tageous commercial and matrimonial engage- 
ments. 

This wish for secrecy is its own worst enemy. 
It perpetuates a blind belief in the unchange- 
able nature of a defect, of its probable existence 
in the whole family, of the likelihood of its 
reappearance in offspring. Moreover, it deters 
from seeking advice and relief, and of necessity 
causes the condition to remain unchanged. 
This is infinitely unfortunate, for there is no 
doubt that many of the defects and their sequels 
can be ameliorated, even if they cannot abso- 
lutely be cured. The methods are not gener- 
ally understood, for the double reason that too 
little discrimination is commonly employed in 
ascertaining the cause and the exact amount of 
damage, and because the treatment is neither 
radical nor startling, but slow, long drawn out, 
and, possibly, discouraging. Nevertheless, so 
long as there is a rational hope of ultimate 
improvement, the parents have a duty to per- 
form in using every possible means to obtain it. 



DEFECTIVE CHILDREN 253 

In trying to understand the facts of physical 
and mental defectiveness, one must, first of all, 
recognize its modes of occurrence. The injury 
may be congenital or may occur after birth. 
The congenital cases include microcephalus, 
hydrocephalus, cretinism, birth-paralysis, gen- 
eral disturbance of nervous equilibrium, and a 
wide range of intellectual hebetudes associated 
with the tuberculous diathesis, or certain low 
forms of development which are known by the 
name of "mongol" or "kalmuc." In micro- 
cephalus the brain is much smaller than usual; 
its arrangement of convolutions is too simple, 
and its texture is doubtless coarser than it ought 
to be. The skull is small, it tends to come to 
a point at the top, and possesses a receding 
forehead and a flattened occipital portion. The 
chin, as a rule, recedes sharply, and the gen- 
eral expression is one of vacuity and weakness. 
This condition has no sharply defined limits, 
but exists in so many grades that not a few 
microcephalic children are susceptible of enough 
improvement to give them a bearable position 
in the world. Under this heading one would 
place those children in whom some part of the 
brain is absent, atrophied, or impaired. The 
scope is thus very wide, and actually should be 



254 THE CARE OF THE CHILD IN HEALTH 

made to include persons who are said to be 
"slightly backward," "not over bright," or 
" simple-minded." 

" Congenital hydrocephalus " means a brain 
that at birth contains a relatively large quantity 
of water or serum. The head is large, especially 
above the upper level of the ears, the forehead 
is high and bulging, the occipital portion may 
be notably increased, the fontanelle remains 
patent, and the bones of the skull are very soft 
and yielding. The abnormal amount of fluid 
causes general pressure, retards growth, inhibits 
nutrition, and prevents normal functioning. 
The result is a curious combination of a huge 
head and a really small brain. Associated with 
this deformity is a general weakness of the 
body, a liability to wasting diseases, and a 
comparatively small resistance against convul- 
sions and other cerebral symptoms which are 
due to pressure. 

Cretinism is a remarkable condition which 
occurs endemically in certain localities of Swit- 
zerland and France. In the last few years an 
increasing number of cases have appeared in 
this country. The disease is associated with an 
atrophy or absence of the thyroid gland, and 
has as its apparent symptoms a dwarfing of the 



DEFECTIVE CHILDREN 255 

body and mind, thick and flabby skin, a protu- 
berant belly, a large and projecting tongue, 
broadly set and full eyes, undeveloped face, and 
thick cranial bones. The subjects of congenital 
cretinism do not seem to have much vitality, 
and easily fall into conditions of marked weak- 
ness. The sporadic cases are oftener seen in 
this country than the congenital, and have a 
better chance of life. But the general dwarfing 
is fully as marked in the former as in the latter, 
so that a cretin of twenty years of age may look 
no more than six, eight, or ten years old. In 
all these cases the wonderful improvement 
which modern methods of treatment have made 
possible is a standing rebuke to those who 
despair of helping defectives. 

Birth-paralysis results when some part of the 
body has, during or shortly before parturition, 
been subjected to long-continued pressure. 
There is a widespread belief among anxious 
mothers that the obstetric forceps is responsible 
for a large proportion of these unfortunate con- 
ditions. As a matter of fact the opposite is true. 
The instrument shortens the duration of tedious 
labors for hours or even days, thereby reducing 
the amount of danger. Moreover, if it is prop- 
erly used, the amount of strain which it puts 



256 THE CARE OF THE CHILD IN HEALTH 

upon the child is not great enough to be in- 
jurious. A labor that is long drawn out, that 
depresses the mother's physical resources to or 
past the point of toleration, has an equally bad 
effect upon the child. And he will feel these 
unfortunate conditions in proportion to the 
weakness and immaturity of his organism. In 
the obstetric forceps we have an immediate 
means of relief, whose value cannot be too 
highly estimated. 

The tubercular diathesis is responsible for a 
large proportion of the deficiencies in children. 
The process is one of general impoverishment, 
of weakened cerebral circulation, of depraved 
nutrition. There is no classic form which it 
assumes, nor is there any limit at which it must 
necessarily stop. Just as the arms and legs 
may waste away, the power of digestion dimin- 
ish, and the general vitality sink to a low level, 
in the same way the mental force may decrease 
until the intellectual status is a pitiable one. 
In somewhat analogous ways a defective cir- 
culation, which is dependent upon some form 
of congenital heart disease, may occasion an 
impoverishment of the cerebral tissues that 
shows itself in some degree of feeble-mindedness 
as well as muscular weakness. Yet another 



DEFECTIVE CHILDREN 257 

type which doubtless originates in perverted or 
deficient nutrition is the so-called mongol or 
kalmuc; it gets its name from the resemblance 
to the designated races which the facial appear- 
ance suggests, and may be regarded as an in- 
stance of arrested development. The head is 
not large, and the transverse diameter is almost 
as long as the longitudinal. The eyes are apt to 
be obliquely placed, and shaped like an almond; 
the hair is harsh and wiry, the skin is coarse, 
the tongue is rough and marked by transverse 
furrows. Such children represent a condition 
of general incompleteness, which may be illus- 
trated in a partial way by such local deficiencies 
as cleft palate, hare-lip, and the many rarer de- 
formities that result from unfinished growth. 

Under the heading of non-congenital defi- 
ciencies, the main causes of impaired growth 
are the results of violence, disease, nervous 
shock, and serious or long-continued poisoning. 
The traumatic cases may follow a blow or fall 
on the head or spine; those dependent upon 
disease are the ones that have suffered from 
meningitis, scarlet fever, and other disorders 
that may affect the brain and its membranes, 
as well as the organs of special sense. Nervous 
shock may follow marked terror or fright, such 



258 THE CARE OF THE CHILD IN HEALTH 

as is produced by ghost stories, imminent injury, 
pretended apparitions of the " boogy man, " or 
even confinement in the dark. The philosophy 
of these cases is hard to understand, especially 
as we have no standard by which to ascertain 
the amount of disturbance, nor even do we 
know in what organic changes that disturbance 
resides. We are in an almost equally poor way 
concerning the so-called toxic cases, such as 
follow a large use af alcohol, opium, and other 
powerful drugs. And the most that we can 
safely conclude is that in some way the circula- 
tion is weakened, nutrition becomes perverted, 
and local or general starvation follows. 

When we look at these conditions in large 
numbers, we are generally able to recognize 
some common factors which may reasonably 
have acted as the exciting and active cause. 
And there is a great need for a clear view of 
the subject in order that the blame will be 
rightly placed, and also that there shall not be 
a false opinion hanging upon the efforts to im- 
prove or cure. For such a reason there is some 
keen pleasure in being able to condemn the 
likelihood of "maternal impressions" having 
an appreciable share in the causality. The 
tenacity with which this reputed factor main- 



DEFECTIVE CHILDREN 259 

tains its hold upon the popular belief and 
imagination is truly remarkable. And at the 
same time there are almost no good reasons to 
fortify the belief. If it were possible by a 
single impression upon the mother's mind dur- 
ing the period of pregnancy to give an enduring 
character to the child's body or mind, or both, 
an easy way would simultaneously have been 
discovered to influence every unborn child. If 
the sight of some startling animal, the news of 
some striking event, the appearance of some 
unfortunate cripple, can blight or harm the 
foetus, why should it not be possible to direct 
one child to be a musician, another to be an 
orator, another to be a mechanician, by allowing 
the mother to hear respectively a burst of music 
or a powerful speech, or giving her the oppor- 
tunity to witness a fine piece of mechanical 
ingenuity ? Since in every household the busi- 
ness of the family head is apt to take up a large 
part of the wife's attention and thoughts, there 
ought to be as an inevitable consequence an 
almost certain bending of the children's minds 
in the way of the father's business. But as a 
matter of fact we know that a minority of all 
children adopt their father's vocation; and 
when they do, it is rather because of unusual 



260 THE CARE OF THE CHILD IN HEALTH 

advantages which the inertia of the parent's 
success may give them than a congenital liking. 
Let us go yet further and inquire whether, even 
in cases of marked preference of the parents 
for a certain business or profession, the children 
do not show a smaller amount of love or ability 
for the work in question ? Perhaps of all voca- 
tions the one that tinges most strongly every 
circumstance of the family's household and 
general life is the ministerial. And yet it is 
comparatively rare to find a preacher's son 
loving the life and work of a preacher, and 
longing to adopt them. Indeed, in the various 
callings it is a comparatively common thing to 
find that a man's family evince no taste for his 
occupation, or at most that their approbation is 
no more than toleration. 

The plain fact is that the whole subject of 
parental impressions is very misty, without 
well-defined limits, or clearly understood laws. 
Vigorous parents, who are well nourished, are 
very likely to bear vigorous offspring. And 
persons of weak vitality, especially if thej^ are 
poorly nurtured, generally have weakened chil- 
dren. We are able to hand on to our children 
a legacy of our physical constitution and pecu- 
liarities, or those of our ancestors; or possibly 



DEFECTIVE CHILDREN 261 

the combination of the innumerable factors in 
heredity may give a resultant which is different 
from any one of them. The main element in 
all cases is the quantity and quality of nutri- 
tion; and the influence of adventitious effects 
lies in the way of increasing or decreasing that 
nutrition, of keeping it within straight or 
crooked lines. It is not radically different 
from the manner in which children may be 
manipulated and influenced after birth. 

Maternal impressions usually come in the 
form of a single thought, or perception, or 
shock; but we rarely find that such a single 
event can do much toward making or marring 
the mind of a child. If the opposite were true, 
it would be hard to find a normal or healthy 
person ; for the exigencies of ordinary life make 
the occurrence of some sort of shock or unde- 
sirable maternal impression practically unavoid- 
able. "So strong, indeed, is the tendency of 
nature to revert to a healthy type, that the soli- 
tary infraction of physiological law is not often 
visited by the penalty of mental abnormality ; 
and if we only look back far enough we shall 
probably find that such a culmination is reached 
by the gradations of repeated transgressions." 
This statement bears at once a hope and a warn- 



262 THE CARE OF THE CHILD IN HEALTH 

ing. One single act may not be exceedingly- 
important in itself, but that act may be the 
individual expression of a general tendency 
which must, with each repetition, exaggerate 
the tendency to recurrence, or the producing of 
the characteristic effects. 

This idea is regularly proved in our common 
experience. We know quite definitely that 
a tuberculous ancestry diminishes a child's 
vitality to such an extent as to create a pre- 
disposition to contracting local or general 
tuberculosis; at the same time we know that 
a single instance of tuberculosis in a father, or 
mother, or grandparent, does not inevitably 
assure the breaking out of the disease in a child 
or grandchild. Likewise, although we know 
that a majority of defective children have a his- 
tory of tuberculous ancestry, the fact of a single 
case of the disease does not at all mean that 
every child who descends from such a stock 
must be feeble or abnormal in mind. And, 
also, in the same way that we know the possi- 
bility of building up and developing the body 
of a child with a tuberculous predisposition, so, 
likewise, we may reason that the weak-minded 
offspring of a family which is similarly con- 
taminated may be carried past the limits of 



DEFECTIVE CHILDREN 263 

intellectual poverty into the confines of com- 
parative intellectual prosperity. 

Almost the same train of thought applies to 
the defectives whose disabilities have been 
traced to parental or ancestral tendencies 
toward drunkenness. "Not every drunken 
parent procreates an idiot; but when inherited 
nervous instability from this or other causes is 
intensified in the next generation by inju- 
dicious marriage, or by unfavorable environ- 
ment, instances of mental degeneracy are apt 
to occur." A single occasion of excessive 
drinking would in all probability have very 
little to do with depressing a future child's 
mental or physical constitution; but habitual 
excesses, in parents or ancestors, or even the 
habitual use of alcohol to more than a very mod- 
erate degree, might bring about the most un- 
fortunate results. If it did occur, the rational 
cause would not be the mysteriously blighting 
effects of alcohol in itself, but rather the gradual 
and steady deterioration of nervous equilibrium 
which excesses entail. Since the use of alcohol 
lends itself easily to excess, — more so than most 
drugs or foods, — inordinate and unusual drink- 
ing has come to bear its present bad reputation. 

In analogous ways unfortunate circumstances 



264 THE CARE OF THE CHILD IN HEALTH 

during gestation, such as poor maternal health 
or a violent accident, may operate. These 
factors are efficient only in the degree in which 
they are able to lower the child's nutrition, as 
well as the source from which that nutrition has 
its origin. Similarly we can account for the 
occasionally evil results of consanguineous mar- 
riages: here the simple fact of relationship is 
not the all-important consideration. In fact, 
there are many instances of comparatively close 
intermarriage, such, for instance, as those of 
first cousins, whose offspring have been suffi- 
ciently normal. But such marriages have a 
tendency to exaggerate whatever weaknesses of 
body or brain and whatever environmental 
peculiarities the family may have. 

Quite a different principle comes into play 
when the deficiency follows disease. Here 
an inflammatory process is at work which causes 
organic changes in the nervous system. Thus 
a lobar pneumonia may be followed by a men- 
ingitis, and on account of it the meningeal 
membranes may be thickened, their blood-vessels 
may be congested, the products of inflammation 
may accumulate in considerable amounts, and, 
consequently, there is a continuous nervous 
irritation, the normal development is impeded, 



DEFECTIVE CHILDREN 265 

and symptoms of corresponding intensity may 
appear. In an entirely different set of cases a 
new growth, perhaps of syphilitic origin, may 
press upon the surrounding brain tissue; or, 
again, a minute fragment of bone, which has 
been broken off by some accident, may pierce 
the cerebral structures, and cause mental defi- 
ciency, convulsions, and similarly alarming 
manifestations. It is obviously unnecessary to 
go through the whole list of possibilities and all 
their myriad aspects; the great thing which 
we must keep in mind is that commonly enough 
there is an ascertainable cause, and that the 
finding of it is the first step to a logical method 
of improvement. Likewise, as the knowledge 
of cerebral localization and functions grows, 
there is an increasing chance of knowing what 
area is affected, of finding means to increase its 
efficiency, or so far developing some other por- 
tion that it may, in part at least, attend to the 
neglected work. 

The outlook, in all these various cases, dif- 
fers according to the particular circumstances 
involved. As far as a very general rule may 
go, one may safely say that the congenital cases 
offer a better opportunity for successful treat- 
ment than the acquired ones do. For in the 



266 THE CARE OF THE CHILD EST HEALTH 

first class there is generally an unfinished con- 
dition, a state of incompleteness, that is, as 
it were, waiting for an adequate force to give 
the needed impetus toward normal growth. If 
the weakened brain has not been allowed to 
remain too long unhelped, there is a distinct 
possibility of improvement. On the other hand, 
the second series presents a more discouraging 
state of affairs ; for instead of there being merely 
a negative condition, there is a positive organic 
change that may be almost insurmountable. 
Nevertheless, expert information should be 
obtained in regard to every case, and under no 
circumstances should any deficiency, excepting 
capital ones, be accepted as irremediable. 

Thus, as an example, let us take the case of 
a young child who has been afflicted with deaf- 
mutism after scarlet fever. A part of that 
disease is a severe inflammation of the throat. 
As a sequel to this disorder an inflammation of 
the Eustachian tube may begin, which develops 
into some form of middle-ear disease, the result 
of which is deafness. The child, consequently, 
is unable to hear himself or other persons speak, 
he forgets the sound of words, and, finally, is 
unable to use them at all. In children under 
two years of age, the normal limit at which 



DEFECTIVE CHILDREN 267 

speech may be expected, the sounds may never 
have been sufficiently learned, so that deafness 
even more readily than in older children causes 
mutism. Such patients are often thought to 
have suffered an injury to the brain ; but as a 
matter of fact the trouble is a purely local one, 
and may occasionally be relieved or compen- 
sated for by appropriate special instruction, or, 
in some few cases, by treatment of the ear. This 
is by no means the only instance in which a hope- 
ful persistence may be of the greatest benefit. 

It is unfortunate that most cases of defective 
mental condition cannot be treated at home. 
As a rule, the treatment is so wide, it should 
include the oversight of so many parts of the 
child's life, that observation and control must 
be undivided. And each factor may be so 
important that it should not be left to the lib- 
eral interpretation that it usually would receive 
in the ordinary household. Moreover, such a 
household is primarily designed for the needs, 
comforts, and pleasures of normal persons; it 
can only with difficulty subordinate its natural 
usefulness to the needs of an abnormal child. 
These needs are incessant, they must be watched 
day and night. Thus the diet in such cases is 
very important, for a poorly developed or weakly 



268 THE CARE OF THE CHILD IN HEALTH 

balanced brain is more easily affected by an 
imperfect digestion and assimilation than a 
normal pne. The exercise is likewise very 
important, and must be designed for the par- 
ticular child in question. The instruction 
must by all means have the special character 
which the condition of the child demands, and 
it should be prosecuted under the direction of 
expert medical, as well as pedagogical, control. 
Even the child's amusements should be carefully 
regulated and prescribed. In fact, there is no 
item of his whole existence that is too small to 
require careful and conscientious direction. 

The ordinary nurse-maid is unable to do all 
this intelligently and faithfully. In most 
cases she is a somewhat rudimentary person 
herself, whose real and suitable function would 
be as the keeper rather than the nurse of chil- 
dren. While it is true enough that most 
children would be benefited by having less 
expensive clothes and a better qualified nurse, 
nevertheless, in a case of a defective child the 
requirements are so great that a capable person 
is under ordinary circumstances very hard to 
obtain. The natural choice must therefore be 
some form of institution which may not have the 
disadvantages of the usual large asylum in the 



DEFECTIVE CHILDREN 269 

great cities. The proper institution must be 
situated in the country, in a community of its 
own ; it must be built on the cottage or colony 
plan, where only a small number of children 
live in one home, and, therefore, are under the 
direction of one cottage-mother. The amuse- 
ments, the exercises, the instruction — in fact, 
the general life of the child — should be passed, 
as far as possible, in the open air under circum- 
stances which do not bring abnormal children 
in competition with normal boys and girls, 
which would allow an elastic grading, which 
would decrease to the last degree the morbid 
influences that are inseparable from the stress 
and strain of ordinary life. In addition, the 
corps of attendants and instructors should be 
selected for the especial work in hand on other 
principles of choice than those which unfortu- 
nately are too often in vogue. The abnormal 
child is so frequently met, he represents under 
present conditions so much of a loss to himself 
and the world, and his prospects of usefulness 
are so limited, that any change is apt to be for 
the better. And if the improvements are able 
to elevate the condition of only a small percent- 
age, the gain to the world would of necessity be 
immeasurably great. 



CHAPTER XIII 



COMMON DISEASES 



No child can be expected to go through life 
without some deviations from the normal con- 
dition of health; and a general understanding 
of how the main deviations show themselves is 
of so much help in obtaining a return to health 
that every mother should have some information 
on the subject. It is not desirable that she 
should make an absolute diagnosis and conduct 
the treatment without skilled help ; on the con- 
trary, no matter how much experience she may 
have had in her household, she cannot expect 
to have the acquaintance with sickness that a 
trained physician possesses. At the same time 
there is a very important place in the care of 
children for the intelligent mother who has 
sufficient knowledge to prevent her from falling 
into simple errors, to give her the calmness of 
mind in the presence of disease that is so valu- 
able for her child's comfort and welfare, and to 
contribute to her own comfort, efficiency, and 

270 



COMMON DISEASES 271 

ability to care for her household. There are 
the best of reasons why she should have some 
general knowledge of the principal varieties of 
sickness, how they occur, what their general 
course is, and what the logical way of regard- 
ing them is. The knowledge is not especially 
hard to assimilate, and it will undoubtedly 
justify itself. 

The first thing to know and always to keep 
in mind is that disease never comes without a 
definite cause, it never "happens." A child 
may fall and break his arm, or may be struck 
with a ball or a stone, and thus injured; such 
accidents may occur to any one, even if every 
reasonable precaution for his safety has been 
conscientiously observed. But the disorders 
known as definite diseases do not happen in this 
manner; in a large majority of the ordinary 
cases sickness results from the combination of 
two factors : a lessened physical resistance and 
vitality in the child on the one hand, and, on 
the other, the attack by agents of disease that 
are lying in wait for the opportunity to find 
suitable conditions of growth. The deficient 
resistance and vitality may be congenital or ac- 
quired, but usually they arise from errors in the 
general mode of life, or in the failure to obtain 



272 THE CARE OF THE CHILD IN HEALTH 

the requisite degree of health after sickness. 
There is no doubt that some children have 
received the heritage of weakness, of suscepti- 
bility to pathological conditions ; but such chil- 
dren are in the minority. Even in the case of 
the diseases that were commonly supposed to be 
hereditary, the fulfilment of the sinister promise 
is often the result of personal circumstances. 
No disease has had a worse reputation in this 
respect than tuberculosis. It has been so wide- 
spread, so persistent, and so merciless, that its 
occurrence in one member of a family threw a 
shadow of doubt upon the physical stability of 
every other member. It may have appeared as 
pulmonary consumption, as scrofula, as disease 
of the bones ; but under all circumstances it has 
cast a blight upon the confidence which the 
affected families had in themselves, as well as 
that which the public had in them. 

As a matter of cold fact, the heredity of tuber- 
culosis has of late years been doubted and prac- 
tically disproved. And we have found that the 
whole of the matter is contained in the word 
"predisposition." The child of tuberculous 
descent is not born with the germs of the disease 
in him; but his forbears, on account of the 
ravages which the disease accomplished in 



COMMON DISEASES 273 

their bodies, have handed on to their offspring 
a weakened vitality, especially to the disease in 
question. The tubercular condition has sub- 
tracted something from the sum of their physi- 
cal assets, and they bequeath no more than they 
possess. But — and this is a factor of mighty 
import — the human organism has a wonder- 
ful quality of elasticity, a natural tendency to 
revert to health, as in a staple commercial 
enterprise the natural process of physical de- 
velopment always leans toward improvement, 
toward recovery from misfortunes, if abnormal 
losses are curtailed. Thus, although a child 
may be born with a tuberculous history, he is 
almost always susceptible of such development 
of health and strength that his predisposition 
will be overcome, and he will go through life 
unscathed. 

The same idea is true concerning other dis- 
eases which are commonly regarded as hered- 
itary. People at large are very apt to regard 
such disorders as cancer, as insanity, as rheuma- 
tism, as heart disease, in the light of family 
failings which necessarily constitute a standing 
menace against the health and the potential 
activity of each individual concerned. But 
this is not the best way of regarding these 



274 THE CARE OF THE CHILD IN HEALTH 

complaints. At their worst they can leave no 
more persistent trace than tuberculosis, which 
can be guarded against and overcome. In all 
these instances a hopeless pessimism is entirely 
out of place. There is, very probably, a weak- 
ened general resistance, or a weakened resist- 
ance to the attacks of the disease in question. 
But that fact should stimulate the affected fami- 
lies to vigorous efforts whose object is the 
attainment of such robust health that the 
individual as well as the family weakness is 
practically obliterated. 

The second factor in the causation of disease 
is the one of outside agency. This is usually 
of one sort, although it may have many phases. 
The deleterious influence of unfavorable envi- 
ronment is so well known that it scarcely needs 
elaboration. Everybody is so thoroughly ac- 
quainted with the ordinary effects of injudicious 
eating and drinking, poorly arranged clothing, 
irregular habits of rest, recreation, and activity, 
and deficient measures of hygiene, that an ex- 
tended mention of them is unnecessary in this 
place. But another phase of the question — that 
of the invasion of germ life or the micro-organ- 
isms of disease — is not so clearly understood. 
These bacteria are, for the most part, exceedingly 



COMMON DISEASES 275 

low forms of animal life that exist in great quan- 
tities wherever civilization flourishes. There is 
a vast number of these organisms, some of which 
are of use, some of which are harmless, and 
some dangerous to life. The useful ones may 
be concerned in those processes of fermentation 
which are so extensively employed in many 
commercial and domestic activities; the harmful 
ones are active causes of disease. The one sort 
may be concerned in the making or the marring 
of food-stuffs ; the other in the destruction of 
tissue or the production of poisonous matters or 
toxines, the objective manifestations of which 
we call the symptoms of disease. But with all 
of them there must be certain attendant cir- 
cumstances, the existence of which precedes 
their development and growth. These are the 
presence of moisture, warmth, and a suitable 
culture ground. 

In the human body heat and moisture are 
always present ; and the suitable culture 
medium exists in some condition of local or 
general loss of vitality or tone. The body 
when in a perfectly healthy state has a won- 
derful faculty of warding off disease, because 
it has a quality which does not allow the 
peculiar reaction which makes the favorable 



276 THE CARE OF THE CHILD IN HEALTH 

culture medium. A really healthy person does 
not contract consumption, or typhoid fever, or 
measles, or erysipelas, or lobar pneumonia ; not 
because he escapes contact with the provoca- 
tive germs, but because the condition of his 
body does not favor their growth. A person 
whose general strength is intact and whose 
respiratory mucous membranes are quite nor- 
mal is in no danger of consumption ; a child 
who is similarly disposed, whose nutrition is 
unimpaired, whose excretion is normally active, 
does not contract whooping cough, scarlet 
fever, or mumps ; a baby whose vitality is 
not depressed, whose alimentary tract is in a 
vigorous, healthy condition, whose food is 
properly controlled in regard to quality, quan- 
tity, and purity, and who is kept sweet and 
clean, has no likelihood of suffering from 
sprue, stomach troubles, summer complaint, 
or cholera infantum. The equation is one 
that is not hard to understand, for the fac- 
tors are quite evident. And where the patho- 
logical process has once begun, no one is able 
to say where it will stop. 

The characteristic effect of all these diseases 
is the production of some sort of poison, which 
varies according to the manner and source of 



COMMON DISEASES 277 

its production and its particular nature. The 
toxines that are developed during an attack of 
diphtheria are quite different from those which 
follicular tonsillitis produces, and the poison- 
ous effects of typhoid fever bear very little 
relation to those of summer complaint. This, 
naturally, does not prevent two or more of 
these diseases and their respective toxines from 
being simultaneously present in the body, and 
they often are. Thus it is no very rare thing 
for typhoid fever to be complicated by pneu- 
monia, or diphtheria by broncho-pneumonia, 
or lobar pneumonia by meningitis. Indeed, 
the presence of one disease, by weakening the 
body's vital tone, makes the process of con- 
tracting further diseases more easy than it 
otherwise would be. And at the same time 
one can easily see that the outlook, on account 
of the added wear and tear, is correspond- 
ingly more gloomy. But the essential nature 
of these various infections is so different that 
attempts have for some time been made to find 
whether one might not be used to antagonize 
another. So far this line of work has not been 
very successful. 

But another method of treatment has been 
discovered which in the future will unques- 



278 THE CAKE OF THE CHILD IN HEALTH 

tionably be developed to wonderful limits. 
This method recognizes the poison as the main 
part of the disease, and regards the external 
symptoms as merely concomitant facts. Under 
the name of the " antitoxic serum " the world 
has become familiar with this view in the treat- 
ment of diphtheria. The philosophy of it is 
seemingly simple, and consists in the effort to 
familiarize the body with the specific toxines 
by means of injections of them in an attenu- 
ated form. Diphtheria is not the only disease 
in which it is being used. For generations 
we have been employing an analogous treat- 
ment, which is called vaccination, to ward off 
the possible attacks of smallpox. And of 
late, intelligent efforts have been made to pro- 
duce antitoxic serums for lobar pneumonia, 
tetanus (lockjaw), yellow fever, erysipelas, 
blood poisoning, and similar diseases. The 
success has been variable, depending upon the 
ability to obtain the specific micro-organisms in 
pure cultures, upon the experimenters' ability 
to obtain suitable culture media, and other 
related facts in the technique. The main idea 
that is of use to us in this connection is that 
most diseases have as their principal factor 
the direct or indirect production of toxines or 



COMMON DISEASES 279 

poisons which have a dangerous effect upon 
the body in proportion to their virulence. 

The lesson is of universal application in the 
treatment of disease, and applies with the great- 
est force to the care of children. In all their 
sicknesses the first step to take is the thorough 
emptying of the stomach and intestines by 
means of cathartics ; and one of the principal 
details of treatment is the use of such medicines 
and therapeutic measures during the process of 
the disease as will keep up a moderate but 
effectual excretion through the lungs, the in- 
testines, the kidneys, the glands, and the skin. 
Excretion by means of the lungs is promoted 
through the inhalation of pure air, and the 
action of a vigorous circulation; that by means 
of the intestines through medicines, special 
foods, and water ; that by means of the glands 
through medicines ; and that by means of the 
skin through medicines, the action of heat, and 
the use of water. It is obviously impossible to 
define and describe all these various agencies, 
for that would be tantamount to converting 
this book into a treatise on materia mediea and 
the practice of medicine. But out of the mass 
of details we may select a few fundamental facts 
in treatment that are of paramount importance 



280 THE CARE OF THE CHILD IX HEALTH 

in the task of restoring ailing children to 
health. 

All medicines should be as few in number 
and as simple in combination as possible. All 
opiates should be used for children with great 
caution, and opium or its derivatives — such as 
morphine — should practically never be used, 
excepting under unusual circumstances where a 
physician believes them necessary. This rule 
applies with especial force to the employment 
of sleeping mixtures, soothing syrups, and teeth- 
ing syrups which depend for their effect upon 
brutally stupefying the child, without regard to 
the serious consequences that the drugging may 
entail. 

In sickness the food should almost always be 
fluid, should be easily digested, and never given 
in large amounts. It is well to remember that 
the amount of nourishment which the child 
obtains from his food depends less upon the 
quantity which he swallows than upon the 
amount which he digests and assimilates. The 
habit of forcing a child to eat against his will 
is thus a bad one, for he is rarely benefited by 
food which he does not care to take. During 
an acute sickness he does not need a great deal 
of nourishment; and in chronic disorders one 



COMMON DISEASES 281 

can manage by means of tonic medicines, a good 
choice of food, as well as a dainty preparation 
of it, to increase his appetite. It ought not to 
be hard to understand that food may have as 
definite a composition and physiological effect 
as drugs, and that a similar care should be em- 
ployed in its use. Under all circumstances the 
attending physician should be asked to specify 
the exact kinds of food, the manner of prepara- 
tion, the quantity, and the intervals of feeding. 
This is fully as important in most cases as the 
giving of certain prescriptions ; the whole ques- 
tion of diet for ailing children has not been 
receiving the serious attention which it merits. 
Another subject which is almost equally 
important is that of bathing and the action of 
water in sickness. The use of this agent is not 
nearly common enough, nor need it be regarded 
with the distrust and apprehension that solici- 
tous mothers so often feel in connection with 
the treatment of a delicate child. It provides 
our most excellent methods of lowering a high 
temperature, very much better than any coal-tar 
product or fever powder that has ever been dis- 
pensed. It is almost as good for raising a sub- 
normal temperature; and at the same time it is 
noticeably useful as a diaphoretic, as a means of 



282 THE CARE OF THE CHILD IN HEALTH 

relieving local congestions, as a controller of 
defective circulation, and as a capable agent 
of stimulation. In any sickness the treatment 
may well begin with the administration of a 
warm bath in addition to the cathartic ; and 
thereafter the child should be regularly bathed 
at least once a day. The details of duration of 
bath, temperature of the water, and solution of 
medicinal substances in the water, will be in- 
cluded in the directions of the attending physi- 
cian. During the course of the sickness no other 
means will give the same satisfactory results in 
the reduction of temperature; and the graduated 
bath of 100° F. reduced to 80° F., the cool sponge 
bath, and the wet pack will always give far 
better results than any other antipyretic. In 
addition, the value of an ice-bag to an aching 
head, or to a nervously excited heart, is too 
well known to need special mention. Likewise, 
hot- water bags or bottles to the extremities are 
both valuable and comforting when the child is 
suffering from a chill or from a poor circulation. 
Even in the eruptive fevers or in diseases of the 
lungs, the daily warm bath will contribute ease, 
comfort, and a more rapid progression toward 
health. 

In considering the ordinary diseases to which 



COMMON DISEASES 283 

children are subject, one inevitably divides them 
into a few distinct groups, according to the 
functional divisions of the body. Such a view 
is very useful in determining the treatment 
which they should receive. For usually a dis- 
ease cannot be regarded as a distinct entity and 
separated from every other disease. Thus the 
disorders of the alimentary track include those 
of the mouth, the stomach, and intestines ; and 
commonly one leads to another. A child may 
have an attack of sprue or thrush which always 
begins in the mouth. It originates in a lack of 
cleanliness, and if the defect is not remedied 
the parasitic growth may spread to the stomach, 
and convert a trivial disorder into a serious one. 
In the same way, the disorders of the stomach 
may, and commonly do, lead to derangement of 
the intestines. And it requires no more than 
a cursory view of them to show how true this is. 
Most of the gastric disorders in children are 
functional ; that is, they result from interfer- 
ences with the normal work and action of the 
organ, and occur without the presence of defi- 
nite organic changes. As an example, let us 
take the case of an ordinary attack of indiges- 
tion. Such a state generally follows over- 
eating, or eating food which the stomach is 



284 THE CARE OF THE CHILD IN HEALTH 

unable to digest. In well-grown children it 
commonly follows excesses such as are com- 
mitted during holidays, parties, large dinners, 
or any occasion when they are allowed to eat 
cakes, pies, fruits, and candies. In infants it 
may be caused by excessive quantities of milk, 
or milk of an improper composition. The food, 
not being changed and absorbed, remains in 
the stomach, irritates it, undergoes fermen- 
tation and putrefaction. From this process 
poisonous products are formed which bring on 
various degrees of intoxication. Consequently 
we see such symptoms as gastric pain, fever, 
lack of appetite ; the organism tries to free 
itself from the harmful influences by vomit- 
ing or even by diarrhoea. And this imme- 
diately suggests the proper treatment, which 
accords perfectly with the general principle 
mentioned above. Our first duty is to stop 
the food, to give liberal cathartics to clear away 
the offending matter, and then to keep the 
patient as quiet and the nourishment as simple 
as possible in order to allow him to regain his 
physical tone. The fever may be safely and 
efficiently dispelled by baths ; and in many 
cases very little or no additional treatment is 
required. 



COMMON DISEASES 285 

In a comparatively small proportion of cases 
there is a real inflammation of the mucous mem- 
brane of the stomach. Here the pain, vomit- 
ing, fever, headache, and prostration do not 
come on so suddenly, but rather result from 
repeated attacks of functional disorders, or 
possibly from the absorption of notable quan- 
tities of toxic materials. Although the disease 
is comparatively severe and prolonged, never- 
theless the treatment is to be conducted on 
similar lines. The organ is to be thoroughly 
emptied, the diet is to be restricted to such 
easily digestible foods as milk, or clear soups 
without fat. The same principles of rest and 
temperature-reduction hold good in this case 
as in the other; but there may be a necessity 
for the employment of other methods. It may 
be necessary to wash out the stomach, to pre- 
scribe bismuth, or dilute hydrochloric acid, or 
an alakli, such as the bicarbonate of soda. 
These agents need the experience and skill of 
a physician, and never otherwise should they 
be used. 

The disorders of the intestines may like- 
wise be functional or organic. The first may 
follow similar conditions of the stomach, may 
originate from analogous causes even when 



286 THE CARE OF THE CHILD IN HEALTH 

the stomach is not involved, or may result from 
germ infection of the intestinal contents. The 
course of the disease is apt to be longer than 
that of gastric disorders, partly because the con- 
dition is of slower growth, and partly because 
the intestines are hard to clear out. The same 
general plan of emptying the intestine by 
means of cathartics is used, and sometimes is 
supplemented by washing or flushing the lower 
bowel with a large quantity of boiled water by 
means of a rubber tube and a fountain syringe. 
This is the main part of the treatment in the 
summer diarrhoeas of children ; but it may be 
aided, and its benefits increased, by the restric- 
tion of the food to clear soups and broths, and 
the administration of bismuth and tonics. In 
these conditions the need of tonics is unques- 
tionably great, for the loss of flesh and strength 
is always marked. Full baths or sponge baths 
are of use, but all further details of treatment 
must be supplied by the attending physician. 

The organic diseases of the intestines are 
commonly called inflammation of the bowels, 
and are very serious diseases. Not only is the 
digestive and excretory function seriously inter- 
fered with or abolished, but also there is a very 
large amount of pain and prostration. The 



COMMON DISEASES 287 

intensely sensitive intestinal walls are swollen, 
congested, and infiltrated with new elements; 
and every movement of the body and every bit 
of motion which the intestines undergo produce 
keen agony. The treatment of these conditions 
is too complicated to have a place in this 
chapter. The inflammations of the peritoneum, 
or membrane which lines the abdominal cavity, 
are of much the same nature, they have some- 
what related symptoms and treatment, and 
likewise are scarcely susceptible of interesting 
exploration for the general reader. 

So much of late years has been said about 
appendicitis that some description of it is de- 
sirable. It is commonly spoken of as a "new 
disease " ; but in reality there is nothing new 
about it, excepting that we are now able to recog- 
nize and treat it, while formerly it ran its course 
unrecognized. The appendix is a small process, 
shaped like the finger of a glove, which is given 
off from the large bowel. It is a blind pouch, 
situated in the lower right side of the abdomen, 
and is evidently a vestigial structure which 
serves no useful purpose. On account of any 
injury from violence, or the irritation of in- 
testinal contents, it may fall into a state of 
inflammation. This condition constitutes a fer- 



288 THE CARE OF THE CHILD IN HEALTH 

tile culture ground for germ life, the natural out- 
come of which is the production of pus. If this 
happens, one of two things occurs : the abscess 
may be shut in by adhesions, and may gradually 
be absorbed; or it may break, and flood the per- 
itoneal cavity with pus. From the first con- 
dition the patient may recover, but the disease 
will in all likelihood occur again and again until 
the second condition exists. The usual outcome 
of this is death. The disease should be re- 
garded as an internal abscess which, if it is al- 
lowed to break, causes an active blood-poisoning. 
Every abscess, no matter where it occurs, 
demands opening and the draining off of its 
poisonous contents ; and in appendicitis there is 
no exception to the rule. In case the abscess 
is shut in by adhesions, the operation may be 
postponed until the first acute symptoms have 
passed. But then it should be performed with- 
out delay. The removal of the appendix is 
always a conservative matter, for it removes 
a danger whose gravity cannot be well over- 
estimated. 

Another group of organs which is the seat 
of many common disorders is the respiratory 
system. This includes the nose, larynx, trachea, 
lungs, bronchi, and pleura. The purposes and 



COMMON DISEASES 289 

physical conditions of this system naturally con- 
trol the disabilities to which its various parts 
are subject. Its work consists in drawing into 
the intimate structure of the lungs a certain 
amount of air, from which the oxygen may be 
taken, sucked through the wonderfully fine 
blood-vessels into the blood, where it burns up 
the impurities, and allows the blood stream to 
return, cleansed and rejuvenated, to the heart. 
In the nose the air is filtered and warmed ; it 
is conducted by way of the throat to the trachea 
or wind-pipe, then to the large bronchi, which 
divide into progressively small ramifications 
that resemble the branches of a tree. In the 
throat there are two glands called tonsils, and 
in the back of the nose is a third one, called the 
pharyngeal tonsil, whose function is to lubricate 
the surrounding mucous membrane. These 
tonsillar tissues may become enlarged as the 
result of atmospheric irritations or the action of 
disease, so that the available space through 
which the air passes is markedly decreased. 
The enlargement of the throat or f aucial ton- 
sils is familiar to every one ; but that of the 
third or pharyngeal tonsil, while it occurs fre- 
quently, is not by any means so well known. 
One is very apt to be accompanied by the other. 



290 THE CARE OF THE CHILD IN HEALTH 

At all events, the inevitable result is that the 
amount of air that reaches the lungs is dimin- 
ished, the oxygen is correspondingly decreased 
in quantity, and the burning up of impurities 
in the blood is lessened in equal amount. Here, 
again, we come to a condition of intoxication, 
of poisoning, which shows itself in poor nutri- 
tion and development, in lessened resistance to 
disease, in abnormal conditions of mind. Some 
of the apparent symptoms are tonsillar hyper- 
trophy, and especially the enlargement of the 
pharyngeal tonsil, mouth-breathing, snoring 
during sleep, broadening of the bridge of the 
nose, and a constant recurrence of coughs and 
colds in the head. There is one and only one 
sure remedy for this condition — removal of the 
offending growths. 

There is a certain disease of the faucial ton- 
sils that is sufficiently interesting to require a 
special mention ; and it acquires a part of its 
interest from its liability to be mistaken for 
diphtheria. This disease, on account of its 
manner of occurrence, is called follicular ton- 
sillitis. At the beginning the follicles become 
deeply inflamed as the result of germ infec- 
tion, and their mouths are filled with small 
plugs of membrane. The tonsil now looks 



COMMON DISEASES 291 

red, large, and studded with small patches or 
dots of cream-colored membrane. If these 
patches are large in number they may coa- 
lesce, and form a continuous membrane. The 
behavior of the sickness is alarming ; there is 
increasing difficulty in swallowing, there is 
great depression and general pain, and the tem- 
perature mounts to startling heights, as high as 
105° F. or even more. The severity of the 
symptoms is, curiously enough, not at all in con- 
sonance with the danger of the disease ; for the 
children practically always recover, and are 
very little the worse for their sickness, with the 
exception of a temporary weakness. This dis- 
ease, which in its extrinsic character bears a 
resemblance to diphtheria, is in reality not at 
all like it. The latter is a serious disorder, has 
a moderate or low temperature, not so much 
pain, and its membrane may appear on any part 
of the throat or nose as well as on the tonsils ; 
but if it does begin on the last named structures, 
it steadily spreads to the adjacent parts. The 
treatment of follicular tonsillitis is simple, and 
is really directed most of all to the relief of the 
general distress. It consists in the adminis- 
tration of a brisk cathartic, followed by the ad- 
ministration of small doses of phenacetine and 



292 THE CARE OF THE CHILD IN HEALTH 

saiol in frequent doses ; a cleansing spray to the 
throat and an ice-bag to the neck will increase 
the patient's comfort and hasten recovery. But 
while the treatment of this disorder is simple 
enough, one should not undertake it unless the 
diagnosis is quite correct. No one but a medi- 
cal man should assume the responsibility of 
making the distinction between follicular ton- 
sillitis and diphtheria, and even he may at 
times be enough in doubt to need the aid of 
a bacteriological culture. 

Colds in the head are irritations or inflam- 
mations of the mucous membranes of the nose. 
They may follow harsh atmospheric conditions, 
exposure to draughts, or attacks by certain 
germs. Although they are not in themselves 
serious, they cause considerable discomfort and 
open a way to more dangerous disorders. They 
may be mitigated or driven away by the use 
of cathartics, hot baths, and continuously spray- 
ing the nose with an alkaline, antiseptic solution, 
such as may be obtained at any drug-shop. If 
they are neglected, they commonly extend along 
the nose to the throat, and then into the large 
bronchi, where they start an inflammation called 
bronchitis. When they settle in the throat, 
they often affect the larynx, and produce symp- 



COMMON DISEASES 293 

toms of cough, hoarseness, and loss of voice. 
Sometimes the larynx becomes so sensitive that 
small irritations bring on a spasm which we call 
croup. This condition is temporarily relieved 
by the inhalation of steam, the application of 
heat to the neck, and the use of hot baths. 
The medical treatment, which is important, 
must be left to the attending physician. 

In the treatment of bronchitis the parents 
must by all means free themselves from certain 
time-honored beliefs which should be called 
superstitions. Children suffering from this 
disease need not be swathed in blankets and 
pads until they resemble mummies, they need 
not be kept unwashed during the course of the 
sickness, and they will not be killed by a breath 
of fresh air. On the contrary they should be 
kept comfortably warm, but not hot ; they may 
with advantage have a warm bath morning and 
night ; and the sick-room should always be well 
ventilated. One should keep in mind that most 
of these cases are examples of germ infection, 
and that they require a vigorous excretion, a 
satisfactory stimulation, and a bland soothing of 
the cough and pain. The same requirements 
are needed in lobar pneumonia, which must be 
treated as an acute, infectious disease. Here 



294 THE CARE OF THE CHILD IN HEALTH 

the chief danger is not primarily due to the 
cough or the interference with the breathing, 
but rather to the strain which is put upon the 
heart by the impeded circulation and the poison- 
ous effect of the characteristic germs. Therefore 
the treatment is one of excretion and stimu- 
lation, the drawing off of waste products, and 
the maintaining of strength until the disease 
has subsided. The use of plasters, poultices, 
and pneumonia jackets serves no good end, 
but on the other hand may easily delay 
recovery, or increase the danger of the dis- 
ease. 

Broncho-pneumonia is a compound disease 
made up of a combined attack of a bronchi- 
tis and a pneumonia. This also is practically 
always caused by the invasion of micro-organ- 
isms ; and the essential nature of the complaint 
is the same, in general ways, as the separate 
disorders. The danger, especially for infants, 
is an imminent one, and cannot well be over- 
rated. The successful treatment of this con- 
dition, with its exhausting inroads upon the 
child's vitality, calls for the exercise of the phy- 
sician's best efforts. And while the parents 
may not hope to do more than appreciate the 
gravity of the situation, their intelligent efforts 



COMMON DISEASES 295 

to carry out his directions may make his task 
easier and possibly more successful. 

With any of these diseases an attack of 
pleurisy may be associated, or it may occur 
alone. This inflammation has certain points of 
resemblance to that of the peritoneum. Both 
diseases attack serous membranes, both may 
be simple, or characterized by the presence of 
serum or water, or by the additional factor 
of pus. In the simple, or dry, form the main 
requirement is the easing of pain and the main- 
tenance of strength ; in the serous form there is 
the additional necessity of eliminating the fluid. 
This serum, if moderate in amount, may be 
disposed of by absorption or may call for the 
operation of tapping or draining the chest. 
But the third form, which is characterized by 
the presence of pus, is really a large abscess, and 
demands an immediate incision in the chest 
wall, the evacuation of the pus, and the con- 
tinued drainage of the cavity until all septic 
matter has been thoroughly removed. 

There is only one other class of diseases that 
should be considered in this place, and that is 
the eruptive fevers, such as measles, scarlet 
fever, chicken-pox, typhoid fever. Each one 
is caused by a specific germ, and represents 



296 THE CARE OF THE CHILD IK HEALTH 

a form of poisoning. Here again the main 
necessities which the treatment must meet are 
sustaining the patient's strength, getting rid of 
waste products, diminishing as much as possi- 
ble the amount of work which the body has to 
do, and relieving the unpleasant symptoms in 
every possible direction. One can easily see 
how important it is to clear the alimentary 
track, to use frequent baths, to allow enough 
drinking water for the quenching of thirst and 
the flushing out of the kidneys, to make the 
diet as nutritious and as easily digestible as 
possible, and at the same time to maintain as 
high a degree of strength as the patient's cir- 
cumstances will permit. The mucous mem- 
branes of the nose, throat, and eyes must be 
kept as clean as possible. For this reason they 
should be douched and bathed as often as cir- 
cumstances demand ; and as a reward the 
parents will have a much smaller percentage 
of complications in these and the neighboring 
parts to contend with. There is no need for 
the various teas that formerly were so plenti- 
fully used nor for the burdensome swathing in 
many flannels that is almost as hard to bear as 
the disease itself; the patients must be made 
comfortably cool, should be allowed to drink a 



COMMON DISEASES 297 

sufficient quantity of pure water, and should 
be kept in a cool, dark room, where their nerv- 
ous irritability will have the least provocations 
to get beyond control. In all these diseases 
rigid isolation of the patient is most important, 
and the parents must willingly cooperate with 
the physician in checking the spread of the 
sickness. In many homes, in the presence of 
a contagious disease, the custom exists of put- 
ting the uncontaminatecl children in the sick 
room or even in the bed of the patient in order 
to have the sickness become general, and thus 
be done with it. The practice is most heartily 
to be condemned. It increases the amount of 
sickness and the risk of unfortunate results, 
while it gives no positive assurance that the 
children will be protected against future at- 
tacks. Indeed, these illnesses may occur more 
than once in the same child, and do so with a 
fair amount of frequency. In addition, such 
lax ideas make the whole plan of rational isola- 
tion void, they foster the belief in the necessity 
of sickness, and really have no rational thought 
to justify them. In the whole matter of sick- 
ness, the tendency of endeavor should be in 
the way of directness, common sense, and 
plain thinking. The care of the sick child 



298 THE CARE OF THE CHILD IN HEALTH 

is really that of his healthy brother, some- 
what developed in a special direction to meet 
special exigencies. In both there is need of 
devotion, clear-sightedness, patience, and self- 
denial. And in both the rewards of successful 
effort are doubtless more satisfactory and prof- 
itable than those in any other sort of work. 

Not every one has the privilege of partici- 
pating in such work ; but those who have the 
opportunity should call themselves fortunate. 
To such is intrusted the making of the present 
and the future. The mother, if she only knew 
the length and breadth of her possible influ- 
ence, might be the grand and beneficent figure 
in our society. Her body and mind are the 
patterns of future generations ; by her thoughts 
and deeds she can control and modify the effects 
of long-past times. Her aspirations and ideals 
are the standards by which the world is moved. 
Her life, no matter how hard and common-place 
it may be in its outer aspects, is capable of 
beautiful expression. Real sordidness inheres 
in the characteristic spirit of one's heart and 
soul, rather than in the physical environment 
of one's daily activity. Viewed in this light 
the ordinary, and possibly monotonous, care of 
a child may take on a great significance. His 



COMMON DISEASES 299 

clothing, his bathing, his food, his rest, his 
exercise, become matters of paramount impor- 
tance. To watch the blossoming of his body 
and mind gives an indication of munificent 
potentialities, a vision of never-ending develop- 
ment. To control these things is to have a 
sovereign power over events both great and 
small. This is the greatest career in the 
world ; it provides boundless opportunities for 
the exercise of thoughtfulness, wisdom, affec- 
tion, careful preparation, and discretion. Its 
rewards are as great as its opportunities ; and 
the proportion between these opportunities, 
when they are rightly used, and these rewards 
is exact and never-failing. 

The contemplation of such conditions is truly 
inspiring, for the range of the ideal mother's 
activity is scarcely to be limited. There is no 
chance of business failure, no likelihood of un- 
appreciated or misunderstood motives, no possi- 
bility of crushing competition. On the contrary, 
the active creator of a wise environment, the 
steadfast disciple of adequate methods of child- 
rearing must necessarily live in an atmosphere 
of altruistic endeavor, of normal strength, of 
satisfied desires, of the consciousness of definite, 
human ambitions whose ends are always worthy. 



300 THE CARE OF THE CHILD IN HEALTH 

The air of strenuous, long-continued devotion 
is a healthy one for human beings, and the 
development which it perforce entails lies all 
in the way of ideal growth. This is the foun- 
dation of civilization, the very essence of the 
best part of our modern culture. Those who 
wilfully neglect such a career not only are 
lacking in sense of duty, but also map out for 
themselves a life of pettiness, of unprofitable 
struggling, of unsatisfying pleasures. Here is 
a difference such as exists between beauty and 
ugliness, between right and wrong, between 
life and death. 



INDEX 



Abdomen, pendulous, 44. 
Abdominal band, 52. 
Adenoid vegetations as cause 

of defective sleep, 44. 
Afternoon nap, 132. 
Alcohol, 258. 
Alcohol rubbings, 117. 
Ankle shoes, 177. 
Antipyretics, 281-282. 
Antitoxines, 278. 
Aphasia, functional, 198. 
Appendicitis, 287. 
Arithmetic, study of, 235-236. 
Artificial foods, 89-92. 



Baby's outfit, 47. 
Bacteria, 274-276. 

conditions for growth of, 275. 
Band, abdominal, 52. 
Barrow coat, 55. 
Base-ball, 159. 
Basket-ball, 159. 
Bassinet, 51. 
Bath, in eruptive fevers, 282. 

sponge, 282. 

temperature of, 115. 

time for, 115. 
Bath apron, 116. 
Bathing, 111. 

at three and one-half years, 
120. 



Bathing, freedom from draughts 
during, 115-116. 

in second year, 119. 

in sickness, 281. 

in summer, 118. 

method, 116. 
Bath-tub in nursery, 65-66. 
Bib, infant's, 59. 
Bicycle saddle, 155. 
Bicycling, 154. 
Birth-paralysis, 255. 
Bladder, control of, 187, 188. 
Blanket, pinning, 55. 
Boogy man, 192, 245. 
Booties, 55. 

Bottles, nursing, care of, 86-87. 
Bronchitis, 293. 
Broncho-pneumonia, 294. 

C 

Cancer, heredity of, 273. 
Cape for pregnant women, 42. 
Carbohydrates, function of, 98. 
Carnrick's Soluble Food, 91. 
Cattle, inspection of, 79. 
Changing ideals of women, 10- 

11. 
methods in commercial life, 

7. 
Chicken-pox, 295-296. 
Chinese method of dressing, 

167. 
Cleanliness of nursery, 65. 
Cloak for pregnant women, 42. 



301 



302 



INDEX 



Clothing, color of, 169. 

for children, 163. 

for play, 174. 

for sensitive skins, 167. 

for summer, 169. 

for winter, 169. 

function of, 164. 
Cold in throat, 292-293. 
Colds in head, 292. 
Colors of clothing, 169. 
Comforter, artificial, 136. 
Comforters, 186-187. 
Common diseases, 270. 
Companions, 221. 
Concentration, 201. 
Condensed milk, 91. 
Conditions for sleep, 131. 
Conduction, 164. 
Consanguineous marriages, ef- 
fects of, 264. 
Constipation, habitual, 105. 
Control of bladder and rectum, 

187-188. 
Cool baths, 121. 
Cooperation of parents and 

children, 220. 
Corsets for pregnant women, 
37, 39. 

use of, during exercise, 158. 
Corset waists for pregnant 

women, 37. 
Cotton, nature of, 167. 
Country, living in, 214. 
Courtesy in children, 193. 
Cowardice in children, 191-192. 
Creed, 246. 
Cretinism, 254-255. 
Cruelty in children, 190. 

D 

Dancing, 156. 

Da Vinci, Leonardo, example, 
of, 2. 



Deaf-mutism, 266. 
Decoration of nursery, 63. 
Defective children, 251. 
cause of, 253. 
institution for, 269. 
Deflected nasal septum as 

cause of disturbed sleep, 

144. 
Devotion of parents, 206. 
Diaper, material for, 51. 

size of, 52. 
Diaper-cover, impervious, 58. 
Diet for child of fifteen months, 

96. 
Difficulties in home making, 

12-13. 
Disease, always has a cause, 

271. 
effects of, 276. 
Diseases of stomach and intes- 
tines, 283. 
Domestic careers, 15-16. 
Douche baths, 121. 
Dreams, 142. 

Dress, simplicity in, 178-179. 
Dressing, Chinese, method of, 

167. 
Driving, 160. 

Drunkenness, inherited, 263. 
Duty of father, 212-213. 

E 

Ears, cleanliness of, 117. 

Echolalia, 198. 

Economy of time in arranging 

daily work, 33. 
Education, 225. 

age for, 225-228, 229. 

by example, 230. 

for children under kinder- 
garten age, 231. 

in kindergarten, 232-234. 

in primary school, 234. 



INDEX 



303 



Education, of the home, 230. 

plan of, 242-243, 249. 
Effect of disease, 276. 
Elements of food, 98. 
Enlarged tonsils, 290. 
Enthusiasm in work, 1-2. 
Environment, meaning of, 207. 
Equestrian tights for pregnant 

women, 37. 
Ethics, 243. 
Evaporation, 164-165. 
Excretion, in medical treat- 
ment, 279. 
Exercise, 146. 

a necessity, 148-149. 

for child of five years, 152. 

for child of ten years, 159. 

for child of three years, 151. 

for girls, 157. 

girls' costume for, 158. 

of infants, 150. 
Exposure of nursery, 59. 
Eyelids, cleanliness of, 116. 



Fabrics, difference between va- 
rious, 166. 
Family pleasures, 217. 
Fats, function of , 98. 
Fear, of darkness, 192. 
of lightning and thunder, 
192-193. 
Feather beds, use of, 137. 
Feeding, during second year, 
95 et seq. 
for child over three years, 103. 
for child of one and one-half 

years to three years, 102. 
for child over fifteen months, 

101. 
infant, by teaspoon, 89. 
infant, intervals, 84. 
infant, quantities, 84. 



Feeding in sickness, 280-281. 

of infant, 70. 
Fencing, 159. 

Fermentation of food, 284. 
Fever powders, 281. 
Filtered water, 108. 
Flax, nature of, 167. 
Floor of nursery, 62. 
Follicular tonsillitis, 291. 
Food and sleep, comparative 

value of, 129. 
Food, best, for infant, 71. 

elements of, 98. 
Foods, artificial and proprie- 
tary, 89-92. 
Foot-ball, 159. 
Fun, love of, 220. 
Function of the pregnant wo- 
man, 23. 
Furnishing of nursery, 59. 

G 

Garters, round, 173. 

Gastric disorders, 283. 

Gastric juice in infancy, 99. 

Geography, study of, 239-241. 

Gerber's Food, 91. 

Germs, 274-276. 

Ghost stories, 192. 

Golf, 160. 

Grammar, study of, 236-237. 

Gymnasium at home, 161. 

H 

Habit, and heredity, 181. 

and plasticity, 181. 

force of, 180. 

of being quiet, 184. 

of cleanliness, 187-188. 

of nail biting, 199. 
Habits, 180. 

of courtesy, 193. 



304 



INDEX 



Habits, of cowardice, 191. 

of cruelty, 190. 

of obedience, 189. 

of regularity, 189. 

of restlessness, 184-185. 

of speech, 194-195. 

of sucking, 186. 

of tastefulness, 193. 

of tongue sucking, 186. 

of tongue swallowing, 186. 

of tyranny, 190. 

time for forming, 184. 
Habitual constipation, 105. 
Hamper, 51. 
Hawley's Food, 91. 
Heart disease, heredity of, 273. 
Heat depression, relieved by 

baths, 118. 
Hernia, umbilical in infants, 

53. 
Home gymnasium, 161. 
Horlick's Food, 90-91. 
Hour for retiring, 133. 
HubbelPs Prepared Wheat, 91. 
Hydrocephalus, congenital, 254. 



Ice-box for nursery, 65, 68. 

Imitation, 246. 

Imperial Granum, 91. 

Impressibility of children, 210- 
211. 

Inebriety, inherited, 263. 

Inefficiency of women in house- 
hold, 10. 

Infant-feeding, intervals, 84. 
quantities, 84. 

Inherited weakness, 272. 

Insanity, heredity of, 273. 

Insomnia, 138. 

Inspection of cattle, 79. 

Intestinal disorders, 285. 

Irrigating bowels, 286. 



Isolation in communicable dis- 
ease, 296. 

K 

Kalmuc type, 253, 257. 
Kindergarten, 232-234. 
Knickerbockers, boys', 173. 
Knowledge of sex, 218. 



Lactated food, 91. 

Lactopreparata, 91. 

Language, study of, 243. 

Laryngitis, 292. 

Late age of marriage, 7. 

Layette, list of articles in, 49. 

Leather for shoes, 178. 

Leggings for pregnant women, 
43. 

Liebig foods, 90-91. 

Life-work of women, 4-5. 

Light in sleeping-room, 138. 

Lime-water in milk modify- 
ing, 86. 

List of articles in layette, 49. 

Lobar pneumonia, 293-294. 

Long dresses for infants, 55-56. 

Lying-in, utensils for, 45. 

M 

Mackintosh for clothing, 168. 
Malted milk, 91. 
Management of household 

duties, 33-34. 
Mastication, slow, 109. 
Masturbation, 199, 201. 
Maternal duties, necessity of, 5. 
Maternal impressions, 27-30, 

258. 
Matting for nursery, 62. 
Measles, 295-296. 






INDEX 



305 



Medicines, 280. 
Mellin's Food, 90-91. 
Microcephalia, 253. 
Milk, analysis of human and 
cow's, 80. 

as carrier of infection, 79. 

cow's, boiled, 77-78. 

cow's, cleanliness of utensils, 
77. 

cow's, raw, 77. 

cow's, sterilized, 77-78. 

human, physiological value 
of, 71-72. 

laboratories, 81. 

modification of, 81-86. 

modification of, with lime- 
water, 86. 
Moccasins for children, 176. 
Modification of milk, 81-86. 
Mongol type, 253, 257. 
Morris, William, example of, 2. 
Mother, as educator, 227-228. 

duty of, 211-212. 

function of, 298-300. 
Mother's milk, value of , 71. 

when deficient, 73. 
Mouth, cleanliness of, 117. 

N 

Nail-biting, 199. 

Nap, afternoon, 132. 

Natural wool, 165. 

Navel, rupture of, in infant, 53. 

Need of rest greatest in young 

children, 132. 
Nervous shock, 257-258. 
Nestle's food, 91. 
Nightgown, infant's, 57-58. 
Nightgowns, 133. 
Night lamp, 138. 
Nightmare, 140. 
Night terrors, 141. 
Nipples, care of, 87-88. 



Nitrogeneous foods, 98. 
Nose-picking, 144. 
Nurse-maids, function of, 209. 
Nursery, bath-tub in, 65-66. 

cleanliness of, 65. 

decoration of, 63. 

exposure of, 59. 

floor of, 62. 

furnishing of, 59. 

ice-box for, 65, 68. 

matting for, 62. 

rugs for, 62. 

screen for, 65, 67. 

the, 47. 

toilet chair in, 65. 

ventilation of, 60. 

wall-paper for, 63. 

wash-basin for, 65, 67. 
Nursing, position of infant dur- 
ing, 88. 
Nursing-bottles, care of, 87-88. 

O 

Obedience, 189. 

Obstetric forceps, value of, 255. 

Opiates, 280. 

Opium, 258. 

Outfit, for infant, 47. 

list of articles for, 49. 
Overalls for girls and boys, 

174. 
Over-indulgence, 190. 



Pacifiers, 136, 186, 187. 
Paralysis, birth-, 255. 
Parental impressions, 260. 
Parent, the true teacher, 250. 
Partial sleep, 141. 
Participation in family life, 216. 
Pasteurized milk, 77, 79. 



306 



INDEX 



Pendulous abdomen, 44. 
Penmanship, 238. 
Peptogenic Milk Powder, 91. 
Persistence, 201. 
Pinning blanket, 55. 
Plasticity of children, 208. 
Pleurisy, 295. 

Pneumonia, lobar, 293-294. 
Position during sleep, 137. 
Precocity, a cause of, 133. 
Pregnancy, 23. 

Pregnant women, arrangement 
of duties of, 32. 

cape and cloak for, 42. 

corsets and corset waists for, 
37, 39. 

diet of, 31. 

dressing for, 34. 

equestrian tights for, 37. 

leggings for, 43. 

shoe for, 42. 

skirts for, 40, 41. 

stockings for, 37. 

underclothes for, 35. 

underskirts for, 36. 

waists for, 40, 41. 

wrappers for, 41. 
Pre-marital training, 19, 20. 
Prenatal effects, 27, 30. 
Preparation for child-birth, 

25-26. 
Primary school, 234. 
Proprietary foods, 89-92. 
Proteids, function of, 98. 
Putrefaction of food, 284. 



Radiation, 164. 
Raw milk, 77. 

Rectum, control of, 187-188. 
Regularity in habits, 189. 
Relation between unborn child 
and mother, 24-25. 



Relation of parents to children, 

204. 
Religious training, 243. 
Respiration, function of, 289. 
Respiratory diseases, 289-295. 
Responsibility, for children's 
habits, 202-203. 

in men and women, 4. 

sense of, 3. 
Retiring, time for, 133. 
Rheumatism, heredity of, 273. 
Ridge's Food, 91. 
Riding, 160. 

Robinson's Patent Barley, 91. 
Rocking child asleep, 135. 
Rubber cloth for clothing, 168. 
Rubber shoes, 178. 
Rugs for nursery, 62. 
Rules for infant's garments, 48. 
Rupture of navel in infant, 53. 



Salt baths, 123. 
Scarlet fever, 295-296. 
School, primary, 234. 
Screen for nursery, 65, 67. 
Sea baths, 125. 
Self-control, 201. 
Sex, knowledge of, 218. 
Shock, nervous, 257-258. 
Shoes, ankle, 177. 

for children, 175, 177. 

knitted, for infants, 55. 

for pregnant women, 42. 

rubber, 178. 
Sickness, cause of, 271. 
Silk, function of, 111, 113. 

nature of, 167. 
Simple domestic conditions, 

necessity of, 13-14. 
Singing child asleep, 135. 
Skirts, infant's, 53. 

for children, 172. 



INDEX 



307 



Skirts for pregnant women, 

40-41. 
Sleep, 129. 

and food, comparative value 
of, 129. 

conditions for, 131. 

partial, 141. 

physiology of, 129-130. 

position during, 137. 
Sleeping garments, 133. 
Sleeping mixtures, 280. 
Slip, infant's, 56, 57. 
Snoring, 144. 

Soap for infant's use, 116. 
Somnambulism, 143. 
Soothing syrups, 280. 
Sparring, 160. 
Specialization in work, 8. 
Speech, habits of, 194-195. 

normal limit of acquiring, 
266. 
Spelling, study of, 237-238. 
Sphere, women's, 21. 
Spices, use of, 99. 
Sponge bath, 282. 
Sponge baths in hot weather, 

118. 
Sprue, 283. 
Sucking habits, 186. 
Sucking reflex, 136. 
Sugars, function of, 98. 
Sugar teat, 136. 
Sugar teats, 186, 187. 
Summer clothing, 169. 
Stammering, 197, 198. 
Starches, function of, 98. 
Sterilized milk, 77-78. 
Stockings, for children, 171. 

for pregnant women, 37. 

infant's, 54. 
Stuttering, 196, 197. 
Swimming, 153. 
Swiss foods, 91. 



Table manners for children, 

109. 
Talking in sleep, 144. 
Teeth, care of, 120. 
Teething syrups, 280. 
Tennis, 159. 
Thrush, 283. 
Thumb sucking, 137. 
Toilet chair in nursery, 65. 
Tongue sucking, 186. 
Tongue swallowing, 186. 
Tonsil, pharyngeal, 289. 
Tonsillar hypertrophy, 290. 
Tonsillitis, follicular, 291. 
Tonsils, 289. 

enlarged, 290. 
Toxines, 275, 277. 
Treatment, general, of disease, 

279. 
Tub-bath, 123. 
Tubercular diathesis, 256. 
Tuberculosis, 272. 

heredity of, 272. 
Typhoid fever, 295, 296. 
Tyranny in children, 190. 



U 

Umbilical hernia in infant, 

53. 
Unborn child, 24. 
Underskirts for pregnant 

women, 36. 
Underwear, for children, 170, 

171. 
for pregnant women, 35, 36. 
Union in family, 214, 215. 
Union underwear, 170. 
Unselfishness, 222. 
Utensils for lying-in, 45. 



308 



INDEX 



Ventilation of nursery, 60. 
Vermiform appendix, 287. 
Vocation, women's, 4-5. 
Vulva, cleanliness of, 117. 



W 

Waist for children, 171. 
Waists for pregnant women, 40, 

41. 
Walking, correct, 153. 
Wall-paper for nursery, 63. 
Wash-basin for nursery, 65, 67. 
Washing, occasional, of child, 

118. 
Washing out bowel, 286. 



Water filter, 108. 
Waterproofed wools, 170. 
Weaning, 92, 95. 
Wet-nurse, 75-76. 
Wet pack, 282. 
Winter clothing, 169. 
Women's life-work, 4-5. 
Women's sphere, 21. 
Women's work usually subor- 
dinate, 9. 
Wool, absorbability of, 187. 

natural, 165. 

use of, 165, 168. 

washing of, 168. 
Wrapper for infant, 57. 
Wrappers for pregnant women, 

41. 
Wrestling, 160. 
Writing, 238. 



THE DEVELOPMENT OF THE 
CHILD 

By NATHAN OPPENHEIM, M.D. 
i2mo. Cloth. $1.25 net 



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THE MACMILLAN COMPANY 

66 FIFTH AVENUE, NEW YORK 



THE MEDICAL DISEASES OF 
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By NATHAN OPPENHEIM, 

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THE MACMILLAN COMPANY 

66 FIFTH AVENUE, NEW YORK 



MAY 121900 



